Provider Demographics
NPI:1659665313
Name:FREEMAN, LISA HUMCKE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:HUMCKE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 WADE HAMPTON BLVD
Mailing Address - Street 2:TARGET #1937
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5334
Mailing Address - Country:US
Mailing Address - Phone:864-879-9721
Mailing Address - Fax:864-879-9721
Practice Address - Street 1:6025 WADE HAMPTON BLVD
Practice Address - Street 2:TARGET #1937
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-5334
Practice Address - Country:US
Practice Address - Phone:864-879-9721
Practice Address - Fax:864-879-9721
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist