Provider Demographics
NPI:1750605093
Name:GROSS, LISA ANN
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:BAJUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2230
Mailing Address - Country:US
Mailing Address - Phone:412-825-8441
Mailing Address - Fax:412-717-9010
Practice Address - Street 1:105 MALL BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2230
Practice Address - Country:US
Practice Address - Phone:412-825-8441
Practice Address - Fax:412-717-9010
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042933T183500000X
MD14198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist