Provider Demographics
NPI:1295381903
Name:PAMEN, LIZZIE ATOMI (RPH)
Entity type:Individual
Prefix:DR
First Name:LIZZIE
Middle Name:ATOMI
Last Name:PAMEN
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 1:1401 N TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2325
Mailing Address - Country:US
Mailing Address - Phone:318-254-8731
Mailing Address - Fax:
Practice Address - Street 1:1401 N TRENTON ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2325
Practice Address - Country:US
Practice Address - Phone:318-254-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist