Healthcare Provider Details

I. General information

NPI: 1023366994
Provider Name (Legal Business Name): LISA TOMIC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2012
Last Update Date: 08/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5324 E WASHINGTON ST BLDG A
PHOENIX AZ
85034-2144
US

IV. Provider business mailing address

2925 E ROBIN LN
GILBERT AZ
85296-9426
US

V. Phone/Fax

Practice location:
  • Phone: 602-732-3384
  • Fax:
Mailing address:
  • Phone: 480-813-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS019014
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03127330
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26022139A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051295628
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: