Provider Demographics
NPI:1235950676
Name:NAGLE, LISA R
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:NAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 POTTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8633
Mailing Address - Country:US
Mailing Address - Phone:610-926-3129
Mailing Address - Fax:
Practice Address - Street 1:5471 POTTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8633
Practice Address - Country:US
Practice Address - Phone:610-926-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041040L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy