Provider Demographics
NPI:1427264837
Name:MARSTON, LISA MARIE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MARSTON
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 1:505 S DAVIS AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-5756
Mailing Address - Country:US
Mailing Address - Phone:757-879-0711
Mailing Address - Fax:
Practice Address - Street 1:9520 CHAMBERLAYNE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3901
Practice Address - Country:US
Practice Address - Phone:804-730-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0203010384183500000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program