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:
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 #19495
Mailing Address - Street 2:635 PITTSFORD VICTOR RD
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3921
Mailing Address - Country:US
Mailing Address - Phone:585-248-2770
Mailing Address - Fax:585-248-0861
Practice Address - Street 1:WALGREENS #19495
Practice Address - Street 2:635 PITTSFORD VICTOR RD
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-248-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2025-03-07
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
9103724OtherBPS CERTIFICATION IN GERIATRIC PHARMACY
NY02917926Medicaid
NYI-042009OtherRPH LICENSE
SC7009OtherRPH LICENSE