Provider Demographics
NPI:1366612830
Name:COHN, LISA ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:COHN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:INTERSTATE 40 @ EXIT 102
Mailing Address - Street 2:ACL HOSPITAL PHARMACY DEPT
Mailing Address - City:SAN FIDEL
Mailing Address - State:NM
Mailing Address - Zip Code:87049
Mailing Address - Country:US
Mailing Address - Phone:505-552-5359
Mailing Address - Fax:
Practice Address - Street 1:INTERSTATE 40 @ EXIT 102
Practice Address - Street 2:ACL HOSPITAL PHARMACY DEPT
Practice Address - City:SAN FIDEL
Practice Address - State:NM
Practice Address - Zip Code:87049
Practice Address - Country:US
Practice Address - Phone:505-552-5359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD47101835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy