Provider Demographics
NPI:1194048538
Name:GOHO, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GOHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANISTEO
Mailing Address - State:NY
Mailing Address - Zip Code:14823-1125
Mailing Address - Country:US
Mailing Address - Phone:607-698-4642
Mailing Address - Fax:607-698-2527
Practice Address - Street 1:7 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANISTEO
Practice Address - State:NY
Practice Address - Zip Code:14823-1125
Practice Address - Country:US
Practice Address - Phone:607-698-4642
Practice Address - Fax:607-698-2527
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist