| NPI | 1730534256 |
|---|---|
| Former Name | LISA BOUCHARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 23209) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH 3069) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2016-05-03 |