Provider Demographics
NPI:1427326586
Name:POOLE BROTHERS, LISA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:POOLE BROTHERS
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 1:719 ARBOR SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8415
Mailing Address - Country:US
Mailing Address - Phone:615-519-7925
Mailing Address - Fax:
Practice Address - Street 1:206 CROSSINGS LN
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8547
Practice Address - Country:US
Practice Address - Phone:615-758-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22121183500000X
NC17279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist