Provider Demographics
NPI:1588149488
Name:GOLDEN, LISA LYNN
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:GOLDEN
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 1:1250 N HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2005
Mailing Address - Country:US
Mailing Address - Phone:509-684-3151
Mailing Address - Fax:
Practice Address - Street 1:1250 N HIGHWAY
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2005
Practice Address - Country:US
Practice Address - Phone:509-684-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00016665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist