Provider Demographics
NPI:1154058527
Name:WHIPP, LISA B
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:WHIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 SAIZON ST
Mailing Address - Street 2:
Mailing Address - City:PORT BARRE
Mailing Address - State:LA
Mailing Address - Zip Code:70577-5156
Mailing Address - Country:US
Mailing Address - Phone:337-447-4505
Mailing Address - Fax:337-381-3202
Practice Address - Street 1:418 SAIZON ST
Practice Address - Street 2:
Practice Address - City:PORT BARRE
Practice Address - State:LA
Practice Address - Zip Code:70577-5156
Practice Address - Country:US
Practice Address - Phone:337-447-4505
Practice Address - Fax:337-381-3202
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist