Provider Demographics
NPI:1306122643
Name:MAYER, LISA (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BRITTANY CT
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2148
Mailing Address - Country:US
Mailing Address - Phone:859-341-2205
Mailing Address - Fax:
Practice Address - Street 1:114 BRITTANY CT
Practice Address - Street 2:
Practice Address - City:LAKESIDE PARK
Practice Address - State:KY
Practice Address - Zip Code:41017-2148
Practice Address - Country:US
Practice Address - Phone:859-341-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011725183500000X
OH03122440183500000X
FLPS38578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03122440OtherOHIO BOARD OF PHARMACY
FLPS38578OtherFLORIDA BOARD OF PHARMACY
KY011725OtherBOARD OF PHARMACY