Healthcare Provider Details

I. General information

NPI: 1639546732
Provider Name (Legal Business Name): LISA WOPPERER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31813 TEMECULA PKWY
TEMECULA CA
92592-5870
US

IV. Provider business mailing address

40335 ODESSA DR
TEMECULA CA
92591-6169
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-1244
  • Fax:
Mailing address:
  • Phone: 951-695-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: