Provider Demographics
NPI:1831364116
Name:MCCORMICK, LISA MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:MCCORMICK
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 1:1140 E BISMARCK EXPY
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6603
Mailing Address - Country:US
Mailing Address - Phone:701-255-7220
Mailing Address - Fax:701-255-6029
Practice Address - Street 1:1140 E BISMARCK EXPY
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6603
Practice Address - Country:US
Practice Address - Phone:701-255-7220
Practice Address - Fax:701-255-6029
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist