Provider Demographics
NPI:1003416181
Name:GUAJARDO, LISA WOLFF (RPH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:WOLFF
Last Name:GUAJARDO
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 1:190 APPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-4503
Mailing Address - Country:US
Mailing Address - Phone:281-414-8952
Mailing Address - Fax:
Practice Address - Street 1:5754 KYLE PKWY
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2404
Practice Address - Country:US
Practice Address - Phone:512-268-0412
Practice Address - Fax:512-268-1791
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist