Provider Demographics
NPI:1356445662
Name:MCKAY, LISA N (RPH, BCGP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:N
Last Name:MCKAY
Suffix:
Gender:F
Credentials:RPH, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WALGREENS PHARMACY
Mailing Address - Street 2:101 PATTONWOOD DRIVE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617
Mailing Address - Country:US
Mailing Address - Phone:585-342-0705
Mailing Address - Fax:585-544-3589
Practice Address - Street 1:WALGREENS PHARMACY
Practice Address - Street 2:101 PATTONWOOD DR.
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617
Practice Address - Country:US
Practice Address - Phone:585-342-0705
Practice Address - Fax:585-544-3589
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7009183500000X
NY42009183500000X
NY042009183500000X
DC91037241835G0303X
NYI-042009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02917926Medicaid
SC7009OtherRPH LICENSE
9103724OtherBPS CERTIFICATION IN GERIATRIC PHARMACY
NYI-042009OtherRPH LICENSE