Provider Demographics
NPI:1881967792
Name:PARDEE, LISA MARIE (PHARM-D)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:PARDEE
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-2415
Mailing Address - Country:US
Mailing Address - Phone:715-732-0717
Mailing Address - Fax:
Practice Address - Street 1:1435 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-2415
Practice Address - Country:US
Practice Address - Phone:715-732-0717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13901183500000X
MI5302036812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist