Healthcare Provider Details

I. General information

NPI: 1134279144
Provider Name (Legal Business Name): LISA HOHENTHANER PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14137 LAKERIDGE COURT
MAGALIA CA
95954
US

IV. Provider business mailing address

765 SECLUDED LN
PARADISE CA
95969-3169
US

V. Phone/Fax

Practice location:
  • Phone: 530-873-0460
  • Fax:
Mailing address:
  • Phone: 530-228-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63937
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number63937
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number63937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: