Provider Demographics
NPI:1710064704
Name:HUMBERT, LINDSAY LEE (RPH)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:LEE
Last Name:HUMBERT
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 1:1304 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1354
Mailing Address - Country:US
Mailing Address - Phone:989-894-5018
Mailing Address - Fax:
Practice Address - Street 1:4175 N EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2408
Practice Address - Country:US
Practice Address - Phone:989-667-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2368846Medicare UPIN