Provider Demographics
NPI:1669751202
Name:BOWERMAN, LISA ANN (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BOWERMAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 RIVER BEND CT
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21161-9214
Mailing Address - Country:US
Mailing Address - Phone:570-709-3038
Mailing Address - Fax:
Practice Address - Street 1:10 VILLAGE CENTER RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-6453
Practice Address - Country:US
Practice Address - Phone:410-833-0027
Practice Address - Fax:410-833-0047
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-14
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445876183500000X
MD20216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist