Provider Demographics
NPI:1033404041
Name:LIZARRAGA, TAWNY
Entity Type:Individual
Prefix:
First Name:TAWNY
Middle Name:
Last Name:LIZARRAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 E BASELINE RD
Mailing Address - Street 2:1905
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2140 E BASELINE RD
Practice Address - Street 2:1905
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6910
Practice Address - Country:US
Practice Address - Phone:602-281-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist