Provider Demographics
NPI:1609160050
Name:COTTER, LISA (PHARM-D)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:COTTER
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HOLT GARRISON PKWY
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-5947
Mailing Address - Country:US
Mailing Address - Phone:434-799-9951
Mailing Address - Fax:434-799-9961
Practice Address - Street 1:155 HOLT GARRISON PKWY
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-5947
Practice Address - Country:US
Practice Address - Phone:434-799-9951
Practice Address - Fax:434-799-9961
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist