Provider Demographics
NPI:1811148836
Name:LISH, JESSIE ROSE (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:JESSIE
Middle Name:ROSE
Last Name:LISH
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 1:511 WEST PRATT STREET
Mailing Address - Street 2:APARTMENT 1820
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:908-303-9089
Mailing Address - Fax:
Practice Address - Street 1:511 W PRATT ST
Practice Address - Street 2:APARTMENT 1820
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1648
Practice Address - Country:US
Practice Address - Phone:908-303-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD187641835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist