Healthcare Provider Details

I. General information

NPI: 1639816689
Provider Name (Legal Business Name): LISA NOELLE WITTMIER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 COOPER POINT RD NW STE 103
OLYMPIA WA
98502-4436
US

IV. Provider business mailing address

1022 91ST AVE SE
TUMWATER WA
98501-4678
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-8014
  • Fax:
Mailing address:
  • Phone: 509-339-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number122900
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: