Provider Demographics
NPI:1588740922
Name:FAIRCHILD, LISA KAY (PHARMD, CDE)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:KAY
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:PHARMD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-6127
Mailing Address - Country:US
Mailing Address - Phone:248-703-9994
Mailing Address - Fax:248-879-1795
Practice Address - Street 1:1119 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-6127
Practice Address - Country:US
Practice Address - Phone:248-703-9994
Practice Address - Fax:248-879-1795
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist