Provider Demographics
NPI:1255770988
Name:BRACALE, LISA RAE
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:RAE
Last Name:BRACALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1626
Mailing Address - Country:US
Mailing Address - Phone:614-798-8172
Mailing Address - Fax:614-726-7236
Practice Address - Street 1:6000 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1626
Practice Address - Country:US
Practice Address - Phone:614-798-8172
Practice Address - Fax:614-726-7236
Is Sole Proprietor?:No
Enumeration Date:2013-06-16
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03117389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist