Provider Demographics
NPI:1336743137
Name:GOETTE, LISA LYNN (PHARM D)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:GOETTE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 15TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-7875
Mailing Address - Country:US
Mailing Address - Phone:605-228-2633
Mailing Address - Fax:
Practice Address - Street 1:3820 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-6638
Practice Address - Country:US
Practice Address - Phone:605-225-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist