Healthcare Provider Details

I. General information

NPI: 1679358113
Provider Name (Legal Business Name): LISA HUANG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W CALIFORNIA BLVD
PASADENA CA
91105-3005
US

IV. Provider business mailing address

6006 RENO AVE
TEMPLE CITY CA
91780-1530
US

V. Phone/Fax

Practice location:
  • Phone: 909-815-0933
  • Fax:
Mailing address:
  • Phone: 909-815-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: