Provider Demographics
NPI:1831472836
Name:MAYES, LISA (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:MAYES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-7232
Mailing Address - Country:US
Mailing Address - Phone:606-723-5315
Mailing Address - Fax:606-723-8669
Practice Address - Street 1:1220 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7232
Practice Address - Country:US
Practice Address - Phone:606-723-5315
Practice Address - Fax:606-723-8669
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY010641OtherPHARMACY LICENSE