Provider Demographics
NPI:1013062363
Name:BORRESON, LISA JW (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JW
Last Name:BORRESON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801
Mailing Address - Country:US
Mailing Address - Phone:701-572-4965
Mailing Address - Fax:701-572-6723
Practice Address - Street 1:317 MAIN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801
Practice Address - Country:US
Practice Address - Phone:701-572-6721
Practice Address - Fax:701-572-6723
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist