Provider Demographics
NPI:1912288796
Name:WALKER, LISA IMBROGNO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:IMBROGNO
Last Name:WALKER
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 1:1804 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2105
Mailing Address - Country:US
Mailing Address - Phone:615-327-1894
Mailing Address - Fax:
Practice Address - Street 1:1804 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2105
Practice Address - Country:US
Practice Address - Phone:615-327-1894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39720183500000X
OHRPH.03131967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist