Provider Demographics
NPI:1649894411
Name:AQUILLANO, LISA (PHARMD, BCPS, MSCS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:AQUILLANO
Suffix:
Gender:F
Credentials:PHARMD, BCPS, MSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1633
Mailing Address - Country:US
Mailing Address - Phone:706-344-2230
Mailing Address - Fax:
Practice Address - Street 1:12 EXECUTIVE PARK DR NE STE 556
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2206
Practice Address - Country:US
Practice Address - Phone:404-712-7152
Practice Address - Fax:404-686-2722
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024310183500000X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care