Provider Demographics
NPI:1851889125
Name:CROSSETT, LISA ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:CROSSETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-2714
Mailing Address - Country:US
Mailing Address - Phone:641-828-7312
Mailing Address - Fax:641-828-6303
Practice Address - Street 1:318 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-2714
Practice Address - Country:US
Practice Address - Phone:641-828-7312
Practice Address - Fax:641-828-6303
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy