Provider Demographics
NPI:1730402454
Name:KAPLAN, LISA DIANE (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:KAPLAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:DIANE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:12 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2510
Mailing Address - Country:US
Mailing Address - Phone:631-363-5304
Mailing Address - Fax:
Practice Address - Street 1:12 SUMMERFIELD DR
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2510
Practice Address - Country:US
Practice Address - Phone:631-363-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist