Provider Demographics
NPI:1568637726
Name:HOMMEL, LISA J (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:HOMMEL
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 1:207 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1829
Mailing Address - Country:US
Mailing Address - Phone:802-442-4600
Mailing Address - Fax:
Practice Address - Street 1:207 NORTH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1829
Practice Address - Country:US
Practice Address - Phone:802-442-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033-0003030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013888Medicaid
NY02921575Medicaid
NY02921575Medicaid