Provider Demographics
NPI:1962787952
Name:KING, LISA M (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:KING
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 1:3245 AGENCY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-1993
Mailing Address - Country:US
Mailing Address - Phone:319-758-9991
Mailing Address - Fax:319-758-9989
Practice Address - Street 1:3245 AGENCY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1993
Practice Address - Country:US
Practice Address - Phone:319-758-9991
Practice Address - Fax:319-758-9989
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist