Individual
LISA BASANESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
325 E H ST, IRON MOUNTAIN, MI 49801-4760
(906) 774-3300
Mailing address
1000 WOODWARD AVE, IRON MOUNTAIN, MI 49801-4434
(906) 774-7988
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302028528
MI
Other
Enumeration date
09/19/2006
Last updated
09/11/2008
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