Provider Demographics
NPI:1336422450
Name:ALSOFROM, LISA IRENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:IRENE
Last Name:ALSOFROM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 43RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-4068
Mailing Address - Country:US
Mailing Address - Phone:772-562-0761
Mailing Address - Fax:772-562-6143
Practice Address - Street 1:850 43RD AVE SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-4068
Practice Address - Country:US
Practice Address - Phone:772-562-0761
Practice Address - Fax:772-562-6143
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist