MEDICARE: LISA NG

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	PS54199	FL

General Provider Information

NPI Number	:	1801342589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA NG

Provider Business Mailing Address
First Line	:	285 UPTOWN BLVD #602
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 WELDON BLVD
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3866
Country	:	US
Telephone Number	:	407-688-0575
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	09/15/2016

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