Individual
LISA MARIE DEBOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
324 S. UNION ST, TRAVERSE CITY, MI 49684
(231) 947-4212
(231) 947-0301
Mailing address
1275 VALLEY DR, TRAVERSE CITY, MI 49684-8289
(231) 941-9435
(231) 947-0301
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302027748
MI
Other
Enumeration date
12/13/2006
Last updated
07/08/2007
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