Provider Demographics
NPI:1558085720
Name:LESCAS HERNANDEZ, ZULEMA
Entity Type:Individual
Prefix:
First Name:ZULEMA
Middle Name:
Last Name:LESCAS HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2091
Mailing Address - Country:US
Mailing Address - Phone:503-757-2086
Mailing Address - Fax:
Practice Address - Street 1:14508 NE 20TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6418
Practice Address - Country:US
Practice Address - Phone:503-892-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH611613523336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy