MEDICARE: LISA M HOUK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	6466	CT

General Provider Information

NPI Number	:	1093213795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M HOUK RPH

Provider Business Mailing Address
First Line	:	18 JENIFER LN
Second Line	:
City	:	KILLINGWORTH
State	:	CT
Zip	:	06419-1459
Country	:	US
Telephone Number	:	860-452-4314
Fax Number	:

Provider Business Practice Location Address
First Line	:	665 BOSTON POST RD
Second Line	:
City	:	OLD SAYBROOK
State	:	CT
Zip	:	06475-1524
Country	:	US
Telephone Number	:	860-388-0560
Fax Number	:	860-388-0580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2018
Last Update Date	:	01/28/2018

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