Provider Demographics
NPI:1346339637
Name:LISKA, ANTHONY ADRIAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ADRIAN
Last Name:LISKA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 MESQUITE AVE
Mailing Address - Street 2:SUITE E.
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5771
Mailing Address - Country:US
Mailing Address - Phone:928-855-0106
Mailing Address - Fax:928-855-4653
Practice Address - Street 1:1840 MESQUITE AVE
Practice Address - Street 2:SUITE E.
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5771
Practice Address - Country:US
Practice Address - Phone:928-855-0106
Practice Address - Fax:928-855-4653
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0765460001Medicare ID - Type Unspecified