Provider Demographics
NPI:1891023099
Name:BROCKMAN, LISA MICHELE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:BROCKMAN
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 1:6302 FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4219
Mailing Address - Country:US
Mailing Address - Phone:281-998-7416
Mailing Address - Fax:281-998-9617
Practice Address - Street 1:6302 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4219
Practice Address - Country:US
Practice Address - Phone:281-998-7416
Practice Address - Fax:281-998-9617
Is Sole Proprietor?:No
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist