Provider Demographics
NPI:1942730403
Name:DOCKHAM, LISA JOY (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JOY
Last Name:DOCKHAM
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 1:231 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3538
Mailing Address - Country:US
Mailing Address - Phone:802-891-6737
Mailing Address - Fax:
Practice Address - Street 1:231 LAKE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3538
Practice Address - Country:US
Practice Address - Phone:802-891-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.00032431835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric