Lisa Anne Boothby, PHARM.D., BCPS
Individual provider Active NPI Pharmacotherapy Pharmacist · Peru, IN
NPI 1477607828 · NPPES record last updated Dec 20, 2010
Key facts
- NPI
- 1477607828
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacotherapy Pharmacist 1835P1200X
- License
- 26023438A (IN)
- Practice address
- 275 W 12TH St
Peru, IN 46970-1638 - Phone
- (765) 472-8004
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS34954 | FL | MD | Pharmacotherapy Pharmacist |
| RPH020650 | GA | MD | Pharmacotherapy Pharmacist |
| 26023438A | IN | MD | Pharmacotherapy Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | RPH020650 | GA | |
| Pharmacotherapy Pharmacist | 1835P1200X | PS34954 | FL | |
| Pharmacotherapy Pharmacist | 1835P1200X | 26023438A | IN | Yes |
Addresses
Primary practice location
275 W 12TH St
Peru, IN 46970-1638
Mailing address
2020 E Lou LN
Peru, IN 46970-8652
Phone (765) 460-5066
Other providers in Peru, IN
- Blue Sky Transportation, LLC
- Board of Trustees of Howard Community Hospital
- Kaylee Bohn
- Bona Vista Programs, Inc.
- Bona Vista Programs, Inc.
- Bower Family Dentistry
- Skye Bower
- Marikay Boylan
- Amanda Kay Broughton
- Justin David Brown
All providers in Peru, IN · Pharmacotherapy Pharmacist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.