Provider Demographics
NPI:1346562154
Name:BRICE, LISA L (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:BRICE
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 1:1105 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1521
Mailing Address - Country:US
Mailing Address - Phone:330-722-1808
Mailing Address - Fax:
Practice Address - Street 1:1105 N COURT ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1521
Practice Address - Country:US
Practice Address - Phone:330-722-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-23681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist