Organization
LISKA'S APOTHECARY SHOP, INC.
Active
Parent organization
LISKA'S APOTHECARY SHOP, INC.
Other names
Liska's Apothecary LTC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LISKA'S APOTHECARY SHOP, INC.
Authorized official
ANTHONY ADRIAN LISKA PHARMD (OWNER/PIC)
(928) 855-0106
Entity
Organization
Contact information
Practice address
1840 MESQUITE AVE., STE. E, LAKE HAVASU CITY, AZ 86403
(982) 855-0106
(928) 855-7653
Mailing address
1840 MESQUITE AVE., STE. E, LAKE HAVASU CITY, AZ 86403
(982) 855-0106
(928) 855-7653
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300012
—
AZ
Enumeration date
07/19/2019
Last updated
07/19/2019
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