Provider Demographics
NPI:1497055818
Name:KING, LISA ANNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:KING
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 1:4857 E GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1686
Mailing Address - Country:US
Mailing Address - Phone:602-282-1974
Mailing Address - Fax:602-282-1975
Practice Address - Street 1:4857 E GREENWAY RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1686
Practice Address - Country:US
Practice Address - Phone:602-282-1974
Practice Address - Fax:602-282-1975
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSO9095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist