Provider Demographics
NPI:1104426147
Name:SALMONS, LISA D (PHARMD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:SALMONS
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 1:10203 LARK MEADOW DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4251
Mailing Address - Country:US
Mailing Address - Phone:217-254-7529
Mailing Address - Fax:
Practice Address - Street 1:4840 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3302
Practice Address - Country:US
Practice Address - Phone:502-313-6351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist