Provider Demographics
NPI:1770952418
Name:PHAM, LISA TRAN HOANG MY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:TRAN HOANG MY
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11234 ANDERSON ST LBBY LEVEL
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-4500
Mailing Address - Fax:909-558-0362
Practice Address - Street 1:11234 ANDERSON ST LBBY LEVEL
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-4500
Practice Address - Fax:909-558-0362
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA73465OtherBOARD OF PHARMACY