Basic Information
| Provider Information | |||||||||
| NPI: | 1003139684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | BROWN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1710 SHELBY OAKS DR N | ||||||||
| Address2: | STE 1 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381347403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012015468 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1710 SHELBY OAKS DR N | ||||||||
| Address2: | STE 1 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381347403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012015468 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2010 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 22858 | TN | N | Pharmacy Service Providers | Pharmacist | 183500000X | 09888 | MS | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 10607 | KY | N | Pharmacy Service Providers | Pharmacist |
No ID Information.