Provider Demographics
NPI:1922295443
Name:PIERCE, LISA DIANE (BS PHARM)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DIANE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 GLENN BLVD SW
Mailing Address - Street 2:
Mailing Address - City:FT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968
Mailing Address - Country:US
Mailing Address - Phone:256-677-1416
Mailing Address - Fax:
Practice Address - Street 1:1613 GLENN BLVD SW
Practice Address - Street 2:
Practice Address - City:FT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-4565
Practice Address - Country:US
Practice Address - Phone:256-845-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL166431835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9047OtherNCBOP LICENSE #
AL16643OtherALABAMA BOARD OF PHARMACY