Provider Demographics
NPI:1225375231
Name:VERGARA, LISA LIM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LIM
Last Name:VERGARA
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 1:3101 SW 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7447
Mailing Address - Country:US
Mailing Address - Phone:352-237-3648
Mailing Address - Fax:352-237-4346
Practice Address - Street 1:3101 SW 34TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7447
Practice Address - Country:US
Practice Address - Phone:352-237-3648
Practice Address - Fax:352-237-4346
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS42733OtherSTATE LICENSE