Provider Demographics
NPI:1649072968
Name:HOMEL, NILLIET NAMWERU
Entity type:Individual
Prefix:
First Name:NILLIET
Middle Name:NAMWERU
Last Name:HOMEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8090 GUIDE MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9210
Mailing Address - Country:US
Mailing Address - Phone:360-354-4284
Mailing Address - Fax:
Practice Address - Street 1:8090 GUIDE MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9210
Practice Address - Country:US
Practice Address - Phone:360-354-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61647471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist