Provider Demographics
NPI:1659640720
Name:HAMLIN, LISA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NICOLE
Last Name:HAMLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:NICOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 W COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6225
Mailing Address - Country:US
Mailing Address - Phone:509-482-2790
Mailing Address - Fax:
Practice Address - Street 1:126 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6225
Practice Address - Country:US
Practice Address - Phone:509-482-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00045358183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician