Provider Demographics
NPI:1659351294
Name:DEPRIEST, LISA (PHARMACY TEHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:DEPRIEST
Suffix:
Gender:F
Credentials:PHARMACY TEHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17429 158TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9156
Mailing Address - Country:US
Mailing Address - Phone:425-254-0751
Mailing Address - Fax:
Practice Address - Street 1:14277 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4124
Practice Address - Country:US
Practice Address - Phone:206-431-9652
Practice Address - Fax:206-431-0470
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00019263183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician