Provider Demographics
NPI:1346868064
Name:STRUSS, LISA LEIGH
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LEIGH
Last Name:STRUSS
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 1:2691 17TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:MN
Mailing Address - Zip Code:56452-2666
Mailing Address - Country:US
Mailing Address - Phone:218-682-2320
Mailing Address - Fax:
Practice Address - Street 1:200 BARCLAY AVE
Practice Address - Street 2:
Practice Address - City:PINE RIVER
Practice Address - State:MN
Practice Address - Zip Code:56474-5174
Practice Address - Country:US
Practice Address - Phone:218-587-2500
Practice Address - Fax:218-270-5131
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist