| NPI | 1154852713 |
|---|---|
| Former Name | LISA JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S009130) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 41948) |
| 183500000X Pharmacist (Licence: TX 42839) | |
| 183500000X Pharmacist (Licence: NM RP00007950) | |
| 183500000X Pharmacist (Licence: CO PHA.0019484) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2017-03-24 |