Provider Demographics
NPI:1144507658
Name:DENMARK, LISA MOIRA (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MOIRA
Last Name:DENMARK
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:PO BOX 1315
Mailing Address - Street 2:
Mailing Address - City:N FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-1315
Mailing Address - Country:US
Mailing Address - Phone:508-564-4459
Mailing Address - Fax:508-564-6172
Practice Address - Street 1:111 COUNTY RD
Practice Address - Street 2:
Practice Address - City:N FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-2019
Practice Address - Country:US
Practice Address - Phone:508-564-4459
Practice Address - Fax:508-564-6172
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist