Provider Demographics
NPI:1982986832
Name:SMITH, LISA C (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:SMITH
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 1:700 E DERENNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6716
Mailing Address - Country:US
Mailing Address - Phone:912-354-4853
Mailing Address - Fax:912-354-9356
Practice Address - Street 1:700 E DERENNE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6716
Practice Address - Country:US
Practice Address - Phone:912-354-4853
Practice Address - Fax:912-354-9356
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025788183500000X
IL051290977183500000X
WI14851-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist