Provider Demographics
NPI:1144579657
Name:HUYNH, LISA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2966 E 3RD ST
Mailing Address - Street 2:T-1878
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5424
Mailing Address - Country:US
Mailing Address - Phone:812-336-4101
Mailing Address - Fax:
Practice Address - Street 1:2966 E 3RD ST
Practice Address - Street 2:T-1878
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5424
Practice Address - Country:US
Practice Address - Phone:812-336-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024579A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist