Provider Demographics
NPI:1144718784
Name:KROH, LISA RENEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RENEE
Last Name:KROH
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 1:730 E 100 N
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-7743
Mailing Address - Country:US
Mailing Address - Phone:260-569-0044
Mailing Address - Fax:
Practice Address - Street 1:710 N EAST ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1914
Practice Address - Country:US
Practice Address - Phone:260-569-0044
Practice Address - Fax:260-569-2239
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016352A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist