Provider Demographics
NPI:1174891386
Name:HAMIL, LISA PATRICE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:PATRICE
Last Name:HAMIL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2391
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95063-2391
Mailing Address - Country:US
Mailing Address - Phone:831-239-7336
Mailing Address - Fax:831-479-8606
Practice Address - Street 1:1810 FREEDOM BLVD.
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019
Practice Address - Country:US
Practice Address - Phone:831-768-0183
Practice Address - Fax:831-768-8749
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA027231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist