Provider Demographics
NPI:1841639572
Name:PATHROSE, LIZY P (RPH)
Entity type:Individual
Prefix:MRS
First Name:LIZY
Middle Name:P
Last Name:PATHROSE
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 1:170 SAXER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2335
Mailing Address - Country:US
Mailing Address - Phone:610-543-1153
Mailing Address - Fax:
Practice Address - Street 1:170 SAXER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2335
Practice Address - Country:US
Practice Address - Phone:610-543-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036763L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist