Provider Demographics
NPI:1841657921
Name:KESLING, LISA ANN (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:KESLING
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:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-0509
Mailing Address - Country:US
Mailing Address - Phone:574-721-1428
Mailing Address - Fax:
Practice Address - Street 1:1015 MICHIGAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1526
Practice Address - Country:US
Practice Address - Phone:574-516-6576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018281A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist