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General NPI Number Information
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NPI Number | 1801966890
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Entity Type | Organization
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Legal Business Name | LISA FAMILY PHARMACY INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 14137 LAKERIDGE CT.
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City | MAGALIA
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State | CA
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Zip | 95954-0970
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Country | US
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Telephone | 530-873-0460
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Fax | 530-873-0703
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Provider Business Mailing Address
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Address Line | P.O. BOX 970
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City | MAGALIA
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State | CA
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Zip | 95954-0970
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Country | US
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Telephone | 530-873-0460
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Fax | 530-873-0703
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Authorized Official
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Title or Position | PRESIDENT/PIC
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Name | MS. LISA S HOHENTHANER
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Credential | PHARM D
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Telephone | 530-873-0460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY 51582
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY 51582
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License Number State | CA
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