Provider Demographics
NPI:1316156631
Name:HOMBURG, LISA ANNE (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:HOMBURG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 CREEK BEND DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-6038
Mailing Address - Country:US
Mailing Address - Phone:281-338-6905
Mailing Address - Fax:
Practice Address - Street 1:13630 BEAMER RD STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6037
Practice Address - Country:US
Practice Address - Phone:281-464-6300
Practice Address - Fax:281-464-6301
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist