Provider Demographics
NPI:1619703097
Name:PACHECO, ANNALISA (PHARMD)
Entity type:Individual
Prefix:
First Name:ANNALISA
Middle Name:
Last Name:PACHECO
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 1:3625 PINE LAKE DR APT 9
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-2426
Mailing Address - Country:US
Mailing Address - Phone:845-219-4992
Mailing Address - Fax:
Practice Address - Street 1:8660 CLIFFDALE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-5858
Practice Address - Country:US
Practice Address - Phone:910-213-1409
Practice Address - Fax:910-213-1408
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist