Provider Demographics
NPI:1366024507
Name:PLATA, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PLATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 NW RICHMOND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3121
Mailing Address - Country:US
Mailing Address - Phone:206-548-9688
Mailing Address - Fax:206-546-1166
Practice Address - Street 1:655 NW RICHMOND BEACH RD
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3121
Practice Address - Country:US
Practice Address - Phone:206-548-9688
Practice Address - Fax:206-546-1166
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60309247183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician