Provider Demographics
NPI:1770619462
Name:DEZIEL-EVANS, LISA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:DEZIEL-EVANS
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 1:891 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4237
Mailing Address - Country:US
Mailing Address - Phone:954-262-1387
Mailing Address - Fax:954-262-2278
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:NOVA SOUTHEASTERN UNIVERSITY, SCHOOL OF PHARMACY
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-1387
Practice Address - Fax:954-262-2278
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist