Provider Demographics
NPI:1811590698
Name:OCONNOR, LISA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:OCONNOR
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 1:2601 COMMERCE LN
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-5801
Mailing Address - Country:US
Mailing Address - Phone:886-983-9279
Mailing Address - Fax:
Practice Address - Street 1:2601 COMMERCE LN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-5801
Practice Address - Country:US
Practice Address - Phone:886-983-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist