Provider Demographics
NPI:1730388471
Name:DUBCZAK, LISA MARIA (RPH)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIA
Last Name:DUBCZAK
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 1:1585 CENTRAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-5587
Mailing Address - Country:US
Mailing Address - Phone:843-832-4247
Mailing Address - Fax:
Practice Address - Street 1:1585 CENTRAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-5587
Practice Address - Country:US
Practice Address - Phone:843-832-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist