Provider Demographics
NPI:1306159991
Name:KEANEY, LISA (RPH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:KEANEY
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 1:176 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-3462
Mailing Address - Country:US
Mailing Address - Phone:978-686-3058
Mailing Address - Fax:978-686-5466
Practice Address - Street 1:176 HAVERHILL STREET
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3462
Practice Address - Country:US
Practice Address - Phone:978-686-3058
Practice Address - Fax:978-686-5466
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist