Provider Demographics
NPI:1184911810
Name:JESSUP, LISA P (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:P
Last Name:JESSUP
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 1:23 ROCKPOINT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1732
Mailing Address - Country:US
Mailing Address - Phone:617-584-4763
Mailing Address - Fax:
Practice Address - Street 1:515 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2092
Practice Address - Country:US
Practice Address - Phone:508-485-0432
Practice Address - Fax:508-485-0432
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist