Provider Demographics
NPI:1972792943
Name:SCHAEFER, LISA M (RPH)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:SCHAEFER
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 1:20 BRICKYARD DR APT E11
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7089
Mailing Address - Country:US
Mailing Address - Phone:309-662-2135
Mailing Address - Fax:309-888-0865
Practice Address - Street 1:1900 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4577
Practice Address - Country:US
Practice Address - Phone:309-888-0810
Practice Address - Fax:309-888-0865
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014322A183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26014322AOtherRPH LICENSE