Individual provider Active NPI

Lisa Kallas, PHARMD

  • Ambulatory Care Pharmacist
  • Midvale, UT
National Provider Identifier
1316374630
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Care PharmacistTaxonomy code 1835P2201X
License
5601412-1701 Issued in UT
Practice address
7495 S State St
Midvale, UT 84047-2013
Phone
(801) 213-9547
Fax
(801) 213-9553
NPI assigned
Oct 1, 2013
Last updated
Mar 31, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PH60292088 WA
Pharmacist 183500000X 5601412-1701 UT
Ambulatory Care Pharmacist 1835P2201X PH60292088 WA
Ambulatory Care Pharmacist 1835P2201X 5601412-1701 UT Primary

Addresses

Primary practice location

7495 S State St
Midvale, UT 84047-2013

Mailing address

7495 S State St
Midvale, UT 84047-2013
Phone (801) 213-9547

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
5601412-1701UTMDPharmacist
PH60292088WAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1316374630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7495 S STATE ST",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840472013",
            "telephone_number": "801-213-9547",
            "fax_number": "801-213-9553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7495 S STATE ST",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840472013",
            "telephone_number": "801-213-9547",
            "fax_number": "801-213-9553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALLAS",
        "first_name": "LISA",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-01",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH60292088",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "UT",
            "license": "5601412-1701",
            "primary": false
        },
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "WA",
            "license": "PH60292088",
            "primary": false
        },
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "UT",
            "license": "5601412-1701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midvale, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.