Provider Demographics
NPI:1104119718
Name:SMITH, LISA F (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:F
Last Name:SMITH
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 1:7066 HWY 76 W
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-6055
Mailing Address - Country:US
Mailing Address - Phone:864-683-1216
Mailing Address - Fax:864-683-1216
Practice Address - Street 1:7066 HWY 76 W
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-6055
Practice Address - Country:US
Practice Address - Phone:864-683-1216
Practice Address - Fax:864-683-1216
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist