| NPI | 1528512787 |
|---|---|
| Former Name | MICHAELA CAMILLE LYSOGORSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 58966) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 062013) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2019-12-21 |