Provider Demographics
NPI:1235207192
Name:ANZISI, LISA (RPH MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ANZISI
Suffix:
Gender:F
Credentials:RPH MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3908
Mailing Address - Country:US
Mailing Address - Phone:914-381-4447
Mailing Address - Fax:
Practice Address - Street 1:2500 HALSEY ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3639
Practice Address - Country:US
Practice Address - Phone:718-794-7173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist