Provider Demographics
NPI:1104260371
Name:CONROY, ALISA RENEE (PHARMD)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:RENEE
Last Name:CONROY
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 1:4081 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2361
Mailing Address - Country:US
Mailing Address - Phone:414-961-2001
Mailing Address - Fax:414-961-9924
Practice Address - Street 1:4081 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2361
Practice Address - Country:US
Practice Address - Phone:414-961-2001
Practice Address - Fax:414-961-9924
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14167-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist