Provider Demographics
NPI:1093213795
Name:HOUK, LISA M (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:HOUK
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 1:18 JENIFER LN
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-1459
Mailing Address - Country:US
Mailing Address - Phone:860-452-4314
Mailing Address - Fax:
Practice Address - Street 1:665 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1524
Practice Address - Country:US
Practice Address - Phone:860-388-0560
Practice Address - Fax:860-388-0580
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist