Provider Demographics
NPI:1679830327
Name:DEVIA, LISETTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISETTE
Middle Name:
Last Name:DEVIA
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 1:100 MANHATTAN AVE
Mailing Address - Street 2:APT 407
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5240
Mailing Address - Country:US
Mailing Address - Phone:908-447-7637
Mailing Address - Fax:
Practice Address - Street 1:760 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3048
Practice Address - Country:US
Practice Address - Phone:718-618-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055679-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist