Provider Demographics
NPI:1982240909
Name:HANOVER-PAYNE, LISA ANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:HANOVER-PAYNE
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 1:1217 S RANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2519
Mailing Address - Country:US
Mailing Address - Phone:317-843-4431
Mailing Address - Fax:
Practice Address - Street 1:1217 S RANGELINE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2519
Practice Address - Country:US
Practice Address - Phone:317-843-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023277A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist