Provider Demographics
NPI:1073945564
Name:TAM, LISA (CPHT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 S KING ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3030
Mailing Address - Country:US
Mailing Address - Phone:206-235-9047
Mailing Address - Fax:
Practice Address - Street 1:706 S KING ST APT 3
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3030
Practice Address - Country:US
Practice Address - Phone:206-235-9047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60333417183700000X
CA131458183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician