Provider Demographics
NPI:1336774926
Name:MCCONNELL, LISA DAWN (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:MCCONNELL
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 1:555 MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-2213
Mailing Address - Country:US
Mailing Address - Phone:570-742-8253
Mailing Address - Fax:
Practice Address - Street 1:555 MAHONING ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-2213
Practice Address - Country:US
Practice Address - Phone:570-742-8253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039460R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist