Provider Demographics
NPI:1982980074
Name:SILCOX, LISA GRAHAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:GRAHAM
Last Name:SILCOX
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 1:3574 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2165
Mailing Address - Country:US
Mailing Address - Phone:334-671-3701
Mailing Address - Fax:334-671-3717
Practice Address - Street 1:3574 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2165
Practice Address - Country:US
Practice Address - Phone:334-671-3701
Practice Address - Fax:334-671-3717
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist