Provider Demographics
NPI:1770167611
Name:BIKLE, LISHA LYNN (CPHT)
Entity type:Individual
Prefix:
First Name:LISHA
Middle Name:LYNN
Last Name:BIKLE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 LANAFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1111
Mailing Address - Country:US
Mailing Address - Phone:301-667-2406
Mailing Address - Fax:
Practice Address - Street 1:700 CHASE SIX BLVD
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-2059
Practice Address - Country:US
Practice Address - Phone:301-432-3953
Practice Address - Fax:301-432-3955
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT01574183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician