Provider Demographics
NPI:1427225499
Name:WONG, LISA LAI (PHARMD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LAI
Last Name:WONG
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 1:1630 157TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3237
Mailing Address - Country:US
Mailing Address - Phone:917-882-1981
Mailing Address - Fax:
Practice Address - Street 1:50 BOWERY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4801
Practice Address - Country:US
Practice Address - Phone:212-608-0301
Practice Address - Fax:212-608-0903
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist