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General NPI Number Information
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NPI Number | 1497059604
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Entity Type | Individual
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Provider Name | LISA WONG PHARM. D.
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Gender | Female
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 07/04/2022
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Provider Practice Location Address
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Address Line | 498 CASTRO ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-2020
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Country | US
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Telephone | 415-861-3136
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Fax |
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Provider Business Mailing Address
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Address Line | 498 CASTRO ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-2020
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Country | US
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Telephone | 415-861-3136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051294122
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 64115
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License Number State | CA
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