Provider Demographics
NPI:1386958767
Name:LALLY, LISA ANNE (RPH)
Entity type:Individual
Prefix:
First Name:LISA ANNE
Middle Name:
Last Name:LALLY
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 1:1360 HWY 36
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1716
Mailing Address - Country:US
Mailing Address - Phone:732-264-3114
Mailing Address - Fax:732-335-3940
Practice Address - Street 1:1360 HWY 36
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1716
Practice Address - Country:US
Practice Address - Phone:732-264-3114
Practice Address - Fax:732-335-3940
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01869900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist