Provider Demographics
NPI:1689668378
Name:HEILMAN, LISETTE CHRISTINE (RPH)
Entity Type:Individual
Prefix:
First Name:LISETTE
Middle Name:CHRISTINE
Last Name:HEILMAN
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 1:766 BELMONT AVE E
Mailing Address - Street 2:APT 8
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5964
Mailing Address - Country:US
Mailing Address - Phone:206-323-9213
Mailing Address - Fax:
Practice Address - Street 1:621 STATE ROUTE 9 NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8525
Practice Address - Country:US
Practice Address - Phone:425-334-4028
Practice Address - Fax:425-335-1702
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist