Healthcare Provider Details

I. General information

NPI: 1740156546
Provider Name (Legal Business Name): LISA NGUYEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 MOCKSVILLE AVE
SALISBURY NC
28144-2786
US

IV. Provider business mailing address

1100 VIRGINIA DR STE 250
FORT WASHINGTON PA
19034-3278
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-7220
  • Fax:
Mailing address:
  • Phone: 800-982-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30577
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: