MEDICARE: DR. LISA VAN HONG DO PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051.290061	IL

General Provider Information

NPI Number	:	1528266434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA VAN HONG DO PHARM.D.

Provider Business Mailing Address
First Line	:	7906 KOSTNER AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-3534
Country	:	US
Telephone Number	:	847-530-6202
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 ELMHURST RD
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-5605
Country	:	US
Telephone Number	:	847-439-4230
Fax Number	:	847-439-8912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	09/10/2008

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