Provider Demographics
NPI:1609902683
Name:TOLISON, LISA LYNN (PHARMACY TECH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:TOLISON
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 LURLINE AVE
Mailing Address - Street 2:#116
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311
Mailing Address - Country:US
Mailing Address - Phone:818-734-7033
Mailing Address - Fax:818-348-4663
Practice Address - Street 1:7230 MEDICAL CENTER DRIVE
Practice Address - Street 2:#106
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307
Practice Address - Country:US
Practice Address - Phone:818-346-6550
Practice Address - Fax:818-348-4663
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31359183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician