Provider Demographics
NPI:1992125652
Name:CORSALE, LISA H (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:CORSALE
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 1:4990 HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4851
Mailing Address - Country:US
Mailing Address - Phone:859-746-6333
Mailing Address - Fax:859-746-6365
Practice Address - Street 1:4990 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4851
Practice Address - Country:US
Practice Address - Phone:859-746-6333
Practice Address - Fax:859-746-6365
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY01153183500000X
KY0115431835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist