Provider Demographics
NPI:1861970782
Name:LISTON, LAUREN ANN (RPH)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:LISTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1420 DALBORA RD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-7136
Mailing Address - Country:US
Mailing Address - Phone:321-501-8881
Mailing Address - Fax:
Practice Address - Street 1:1024 FLORIDA A1A
Practice Address - Street 2:#120
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937
Practice Address - Country:US
Practice Address - Phone:321-773-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist