Provider Demographics
NPI:1174832059
Name:PASSINO, LISA M (RPH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:PASSINO
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 1:6 WORTHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-8142
Mailing Address - Country:US
Mailing Address - Phone:518-641-3231
Mailing Address - Fax:518-641-3208
Practice Address - Street 1:6 WORTHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WYNANTSKILL
Practice Address - State:NY
Practice Address - Zip Code:12198-8142
Practice Address - Country:US
Practice Address - Phone:518-641-3231
Practice Address - Fax:518-641-3208
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist