Provider Demographics
NPI:1982111258
Name:TIMBERLAKE, LISA P (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:P
Last Name:TIMBERLAKE
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 1:3450 CLAY POND DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-4885
Mailing Address - Country:US
Mailing Address - Phone:901-590-3069
Mailing Address - Fax:901-590-3252
Practice Address - Street 1:8130 COUNTRY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2087
Practice Address - Country:US
Practice Address - Phone:901-590-3069
Practice Address - Fax:901-590-3069
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist