Provider Demographics
NPI:1003093873
Name:CHOW, LISAR (RPH)
Entity Type:Individual
Prefix:
First Name:LISAR
Middle Name:
Last Name:CHOW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1507
Mailing Address - Country:US
Mailing Address - Phone:212-722-0014
Mailing Address - Fax:212-722-0514
Practice Address - Street 1:1356 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1507
Practice Address - Country:US
Practice Address - Phone:212-722-0014
Practice Address - Fax:212-722-0514
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY580267Medicaid