Active NPI
Lisa J Mallott, R.PH.
- Pharmacist
- Shelton, WA
National Provider Identifier
1982820528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH15636
- Practice address
- 207 Professional Way
Shelton, WA 98584-4404 - Phone
- (360) 426-4626
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH15636 | WA | Primary |
Addresses
Primary practice location
207 Professional Way
Shelton, WA 98584-4404
Mailing address
2215 62ND Ave NW
Olympia, WA 98502-3469
Phone (360) 754-4340
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH15636 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982820528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2215 62ND AVE NW",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985023469",
"telephone_number": "360-754-4340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 PROFESSIONAL WAY",
"city": "SHELTON",
"state": "WA",
"postal_code": "985844404",
"telephone_number": "360-426-4626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLOTT",
"first_name": "LISA",
"middle_name": "J",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH15636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.