Provider Demographics
NPI:1194320150
Name:SON, LISA GOYLE (PHARMD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GOYLE
Last Name:SON
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 1:3149 E HARRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-4016
Mailing Address - Country:US
Mailing Address - Phone:316-686-1583
Mailing Address - Fax:316-686-1923
Practice Address - Street 1:3149 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-4016
Practice Address - Country:US
Practice Address - Phone:316-686-1583
Practice Address - Fax:316-686-1923
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-169191835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist