Provider Demographics
NPI:1457637001
Name:IGONI, LISA GEORGINA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GEORGINA
Last Name:IGONI
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 1:832 GREEN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7376
Mailing Address - Country:US
Mailing Address - Phone:832-868-2829
Mailing Address - Fax:
Practice Address - Street 1:1863 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4028
Practice Address - Country:US
Practice Address - Phone:832-868-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11183183500000X
TX29870183500000X
TN33347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist