MEDICARE: WENDI LISZKA PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH-0016537	OR

General Provider Information

NPI Number	:	1265937171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDI LISZKA PHARMD

Provider Business Mailing Address
First Line	:	1597 N HEMLOCK ST
Second Line	:
City	:	COQUILLE
State	:	OR
Zip	:	97423-1028
Country	:	US
Telephone Number	:	406-640-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 BROADWAY AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-1201
Country	:	US
Telephone Number	:	541-756-0118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2018
Last Update Date	:	03/24/2018

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Directions to “ WENDI LISZKA PHARMD” Practice Location

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