Provider Demographics
NPI:1851692446
Name:ARGAW, LISSANU L
Entity Type:Individual
Prefix:DR
First Name:LISSANU
Middle Name:L
Last Name:ARGAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 W.M.C . DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-2115
Mailing Address - Country:US
Mailing Address - Phone:614-354-7824
Mailing Address - Fax:410-871-1203
Practice Address - Street 1:444 WMC DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158-4337
Practice Address - Country:US
Practice Address - Phone:614-354-7824
Practice Address - Fax:410-871-1207
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist