Individual
LISA EAST MAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19200 SW MARTINAZZI AVE, TUALATIN, OR 97062-6357
(503) 691-4233
Mailing address
19200 SW MARTINAZZI AVE, TUALATIN, OR 97062-6357
(503) 691-4233
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0010363
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
10363
OR
Other
Enumeration date
07/19/2013
Last updated
04/27/2017
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