Individual
LISA KALLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
7495 S STATE ST, MIDVALE, UT 84047-2013
(801) 213-9547
(801) 213-9553
Mailing address
7495 S STATE ST, MIDVALE, UT 84047-2013
(801) 213-9547
(801) 213-9553
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
5601412-1701
UT
183500000X
Pharmacist
PH60292088
WA
1835P2201X
Ambulatory Care Pharmacist
Primary
5601412-1701
UT
1835P2201X
Ambulatory Care Pharmacist
PH60292088
WA
Other
Enumeration date
10/01/2013
Last updated
03/31/2022
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