Provider Demographics
NPI:1932704541
Name:SLOAN, LISA SUE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SUE
Last Name:SLOAN
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 1:229 CHALLEDON CIR SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8507
Mailing Address - Country:US
Mailing Address - Phone:614-595-0725
Mailing Address - Fax:
Practice Address - Street 1:200 BROADWAY E
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1306
Practice Address - Country:US
Practice Address - Phone:740-587-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03219285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist