Provider Demographics
NPI:1457909319
Name:GREENE, LISA R (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:GREENE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8155 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7185
Mailing Address - Country:US
Mailing Address - Phone:410-819-0507
Mailing Address - Fax:410-819-0847
Practice Address - Street 1:8155 ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7131
Practice Address - Country:US
Practice Address - Phone:410-819-0507
Practice Address - Fax:410-819-0847
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist