Provider Demographics
NPI:1548334840
Name:WONG, LISA M (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:WONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4862 N AVENIDA DE CASTILLA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6069
Mailing Address - Country:US
Mailing Address - Phone:520-577-7670
Mailing Address - Fax:
Practice Address - Street 1:3675 E BRITANNIA DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-5041
Practice Address - Country:US
Practice Address - Phone:520-209-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist