Provider Demographics
NPI:1053400770
Name:TYJEWSKI, LISA (RPH)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:TYJEWSKI
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 1:3498 WHISPERING WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-5402
Mailing Address - Country:US
Mailing Address - Phone:231-777-3572
Mailing Address - Fax:
Practice Address - Street 1:961 SPRING ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3278
Practice Address - Country:US
Practice Address - Phone:231-722-2861
Practice Address - Fax:231-726-5522
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist