Healthcare Provider Details

I. General information

NPI: 1568637726
Provider Name (Legal Business Name): LISA J HOMMEL R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 NORTH ST
BENNINGTON VT
05201-1829
US

IV. Provider business mailing address

207 NORTH ST
BENNINGTON VT
05201-1829
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-4600
  • Fax:
Mailing address:
  • Phone: 802-442-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033-0003030
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: