Provider Demographics
NPI:1538750336
Name:GARRISON, LISA CAROL (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:GARRISON
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175-0096
Mailing Address - Country:US
Mailing Address - Phone:606-932-2138
Mailing Address - Fax:606-932-2120
Practice Address - Street 1:142 DEPOT DR
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175-9306
Practice Address - Country:US
Practice Address - Phone:606-932-2138
Practice Address - Fax:606-932-2120
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist