Provider Demographics
NPI:1790063329
Name:FLANNERY, LISA ANTONIA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANTONIA
Last Name:FLANNERY
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 1:1238 PUTTY HILL AVE
Mailing Address - Street 2:T-1142
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5844
Mailing Address - Country:US
Mailing Address - Phone:216-233-6596
Mailing Address - Fax:
Practice Address - Street 1:1238 PUTTY HILL AVE
Practice Address - Street 2:T-1142
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5844
Practice Address - Country:US
Practice Address - Phone:410-823-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist