Basic Information
| Provider Information | |||||||||
| NPI: | 1477763100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOHERMAN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | JEANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 157 EASTGATE DR | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265085938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042922626 | ||||||||
| FaxNumber: | 3045984871 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265068045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045984858 | ||||||||
| FaxNumber: | 3045984871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RP0004971 | WV | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.