Provider Demographics
NPI:1285149682
Name:ORBAN, LISA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:ORBAN
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 1:12 PARTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9560
Mailing Address - Country:US
Mailing Address - Phone:413-531-1825
Mailing Address - Fax:
Practice Address - Street 1:57 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3195
Practice Address - Country:US
Practice Address - Phone:413-568-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7050183500000X
MA25495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist