Provider Demographics
NPI:1134258288
Name:REASONER, LISA MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:REASONER
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 1:8933 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-9121
Mailing Address - Country:US
Mailing Address - Phone:330-875-4290
Mailing Address - Fax:
Practice Address - Street 1:700 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-1338
Practice Address - Country:US
Practice Address - Phone:330-875-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-19910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist