Provider Demographics
NPI:1154924801
Name:NGUYEN, LISA NGAN B (PHARMD, RPH)
Entity type:Individual
Prefix:MISS
First Name:LISA NGAN
Middle Name:B
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3369
Mailing Address - Country:US
Mailing Address - Phone:781-775-9653
Mailing Address - Fax:
Practice Address - Street 1:350 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5726
Practice Address - Country:US
Practice Address - Phone:617-731-5753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist