Provider Demographics
NPI:1891080412
Name:CHIANG, LISA YICHU (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:YICHU
Last Name:CHIANG
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 1:1893 W MALVERN AVE
Mailing Address - Street 2:T-1383
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2403
Mailing Address - Country:US
Mailing Address - Phone:714-278-9022
Mailing Address - Fax:
Practice Address - Street 1:1893 W MALVERN AVE
Practice Address - Street 2:T-1383
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2403
Practice Address - Country:US
Practice Address - Phone:714-278-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist