Healthcare Provider Details

I. General information

NPI: 1396159646
Provider Name (Legal Business Name): LISA HUANG PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2014
Last Update Date: 06/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W 125TH ST # 45
NEW YORK NY
10027-4511
US

IV. Provider business mailing address

35 W 125TH ST # 45
NEW YORK NY
10027-4511
US

V. Phone/Fax

Practice location:
  • Phone: 212-828-1772
  • Fax:
Mailing address:
  • Phone: 212-828-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number057387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: