Provider Demographics
NPI:1871825042
Name:REIS, LISA GOODNER (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GOODNER
Last Name:REIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2730
Mailing Address - Country:US
Mailing Address - Phone:559-897-7095
Mailing Address - Fax:559-897-4905
Practice Address - Street 1:333 SIERRA ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1707
Practice Address - Country:US
Practice Address - Phone:559-897-1913
Practice Address - Fax:559-897-1430
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist