Provider Demographics
NPI:1215579131
Name:LIONG, ELISSA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:ELISSA
Middle Name:
Last Name:LIONG
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 1:300 PULLMAN STREET
Mailing Address - Street 2:ADMIN BLDG, 2ND FL
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551
Mailing Address - Country:US
Mailing Address - Phone:925-294-7004
Mailing Address - Fax:
Practice Address - Street 1:300 PULLMAN STREET
Practice Address - Street 2:ADMIN BLDG 2ND FL
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551
Practice Address - Country:US
Practice Address - Phone:925-294-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist