Active NPI
Bonnie Lynn Lisch
- Pharmacist
- Euclid, OH
National Provider Identifier
1689278806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03118880
- Practice address
- 22001 Lake Shore Blvd
Euclid, OH 44123-1710 - Phone
- (216) 731-2155
- NPI assigned
- Nov 29, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03118880 | OH | Primary |
Addresses
Primary practice location
22001 Lake Shore Blvd
Euclid, OH 44123-1710
Mailing address
10057 Brushwood Dr
Streetsboro, OH 44241-4304
Phone (330) 606-4671
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0192269 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03118880 | OH | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606608000000",
"number": "1689278806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10057 BRUSHWOOD DR",
"city": "STREETSBORO",
"state": "OH",
"postal_code": "442414304",
"telephone_number": "330-606-4671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22001 LAKE SHORE BLVD",
"city": "EUCLID",
"state": "OH",
"postal_code": "441231710",
"telephone_number": "216-731-2155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISCH",
"first_name": "BONNIE",
"middle_name": "LYNN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-29",
"last_updated": "2020-11-29",
"certification_date": "2020-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03118880",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0192269",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Euclid, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.