Provider Demographics
NPI:1659967800
Name:TENAGLIA, LISA
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:TENAGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-2894
Mailing Address - Country:US
Mailing Address - Phone:781-749-1277
Mailing Address - Fax:781-749-2434
Practice Address - Street 1:294 MAIN ST
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-2894
Practice Address - Country:US
Practice Address - Phone:781-749-1277
Practice Address - Fax:781-749-2434
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH20546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist