Provider Demographics
NPI:1023152527
Name:DINUNZIO, LISA M (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:DINUNZIO
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 1:500 TOWN LINE HWY
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1256
Mailing Address - Country:US
Mailing Address - Phone:860-274-8972
Mailing Address - Fax:860-274-8972
Practice Address - Street 1:500 TOWN LINE HWY
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-1256
Practice Address - Country:US
Practice Address - Phone:860-274-8972
Practice Address - Fax:860-274-8972
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist