Provider Demographics
NPI:1700101805
Name:MCCONKEY, LISA ANN (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:MCCONKEY
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 1:14230 BURNHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-4930
Mailing Address - Country:US
Mailing Address - Phone:952-435-8233
Mailing Address - Fax:
Practice Address - Street 1:14230 BURNHAVEN DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-4930
Practice Address - Country:US
Practice Address - Phone:952-435-8233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118206-6183500000X
WI14031-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist