Provider Demographics
NPI:1194132944
Name:LISENBY, KATELIN MEREDITH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATELIN
Middle Name:MEREDITH
Last Name:LISENBY
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 1:850 5TH AVE E
Mailing Address - Street 2:BOX #870374
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27340 HIGHWAY 86
Practice Address - Street 2:
Practice Address - City:GORDO
Practice Address - State:AL
Practice Address - Zip Code:35466-3578
Practice Address - Country:US
Practice Address - Phone:205-364-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist