Provider Demographics
NPI:1053431049
Name:SMITH, LISA LEE (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LEE
Last Name:SMITH
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 1:1355 DRY RIDGE MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-7674
Mailing Address - Country:US
Mailing Address - Phone:859-824-9964
Mailing Address - Fax:859-823-4500
Practice Address - Street 1:1214 N MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097-8502
Practice Address - Country:US
Practice Address - Phone:859-823-0200
Practice Address - Fax:859-823-4500
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist