Provider Demographics
NPI:1093007874
Name:DOFKA, LISA N (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:N
Last Name:DOFKA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SW MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5723
Mailing Address - Country:US
Mailing Address - Phone:503-225-4917
Mailing Address - Fax:
Practice Address - Street 1:100 SW MARKET ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5723
Practice Address - Country:US
Practice Address - Phone:503-225-4917
Practice Address - Fax:503-655-6690
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00125071835P0018X
IDP94771835P0018X
OR0012507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist