Provider Demographics
NPI:1275741522
Name:MANN, LISA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MANN
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 1:11 LARRY DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3305
Mailing Address - Country:US
Mailing Address - Phone:631-462-3951
Mailing Address - Fax:
Practice Address - Street 1:750 PARK PL
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2110
Practice Address - Country:US
Practice Address - Phone:516-536-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist