Provider Demographics
NPI:1730401050
Name:LEUNG, LISA (RPH)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LEUNG
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 1:2590 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5537
Mailing Address - Country:US
Mailing Address - Phone:718-648-0120
Mailing Address - Fax:718-648-0637
Practice Address - Street 1:2590 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5537
Practice Address - Country:US
Practice Address - Phone:718-648-0120
Practice Address - Fax:718-648-0637
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist