MEDICARE: LISETTE CHRISTINE HEILMAN 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	PH00019116	WA

General Provider Information

NPI Number	:	1689668378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISETTE CHRISTINE HEILMAN RPH

Provider Business Mailing Address
First Line	:	766 BELMONT AVE E
Second Line	:	APT 8
City	:	SEATTLE
State	:	WA
Zip	:	98102-5964
Country	:	US
Telephone Number	:	206-323-9213
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 STATE ROUTE 9 NE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8525
Country	:	US
Telephone Number	:	425-334-4028
Fax Number	:	425-335-1702

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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