Provider Demographics
NPI:1316932643
Name:CHAMBLEE, LISA DENISE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:DENISE
Last Name:CHAMBLEE
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 1:7117 S R ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2701
Mailing Address - Country:US
Mailing Address - Phone:479-452-5351
Mailing Address - Fax:
Practice Address - Street 1:6802 ROGERS AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4010
Practice Address - Country:US
Practice Address - Phone:479-452-6116
Practice Address - Fax:479-484-7409
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist