Provider Demographics
NPI:1639803448
Name:TRIEU, LISA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TRIEU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 ROYAL LN STE 522
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-7801
Mailing Address - Country:US
Mailing Address - Phone:214-414-1440
Mailing Address - Fax:
Practice Address - Street 1:5959 ROYAL LN STE 522
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-7801
Practice Address - Country:US
Practice Address - Phone:214-414-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist