Individual
MRS. LISA ANN WALCZAK THAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
155 E UNIVERSITY DR, GRANGER, IN 46530-4474
(574) 243-9042
Mailing address
155 E UNIVERSITY DR, GRANGER, IN 46530-4474
(574) 243-9042
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
13440-040
WI
183500000X
Pharmacist
Primary
26021574A
IN
Other
Enumeration date
11/15/2011
Last updated
11/15/2011
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