Healthcare Provider Details

I. General information

NPI: 1093439630
Provider Name (Legal Business Name): LISA HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 CITY LINE AVE
PHILADELPHIA PA
19151-2101
US

IV. Provider business mailing address

7520 CITY LINE AVE
PHILADELPHIA PA
19151-2101
US

V. Phone/Fax

Practice location:
  • Phone: 215-477-8401
  • Fax:
Mailing address:
  • Phone: 215-477-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP455918
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: