Provider Demographics
NPI:1811320971
Name:CANCEL, LISA JANE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:JANE
Last Name:CANCEL
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 1:2150 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9456
Mailing Address - Country:US
Mailing Address - Phone:864-542-1426
Mailing Address - Fax:864-433-0569
Practice Address - Street 1:2150 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9456
Practice Address - Country:US
Practice Address - Phone:864-542-1426
Practice Address - Fax:864-433-0569
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist