Provider Demographics
NPI:1801966890
Name:LISA FAMILY PHARMACY INC
Entity type:Organization
Organization Name:LISA FAMILY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOHENTHANER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:530-873-0460
Mailing Address - Street 1:P.O. BOX 970
Mailing Address - Street 2:
Mailing Address - City:MAGALIA
Mailing Address - State:CA
Mailing Address - Zip Code:95954-0970
Mailing Address - Country:US
Mailing Address - Phone:530-873-0460
Mailing Address - Fax:530-873-0703
Practice Address - Street 1:14137 LAKERIDGE CT.
Practice Address - Street 2:
Practice Address - City:MAGALIA
Practice Address - State:CA
Practice Address - Zip Code:95954-0970
Practice Address - Country:US
Practice Address - Phone:530-873-0460
Practice Address - Fax:530-873-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 51582333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0553962OtherNCPDP
CAPHY 51582OtherCALIFORNIA STATE BOARD OF PHARMACY PERMIT
CA1801966890OtherMEDI-CAL PROVIDER