Provider Demographics
NPI:1942573928
Name:FRIEDLY, LISA B (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:FRIEDLY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:B
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:14840 SE WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-3249
Mailing Address - Country:US
Mailing Address - Phone:503-303-1090
Mailing Address - Fax:503-303-1075
Practice Address - Street 1:14840 SE WEBSTER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-3249
Practice Address - Country:US
Practice Address - Phone:503-303-1090
Practice Address - Fax:503-303-1075
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00086051835P0018X
OR8605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist