Provider Demographics
NPI:1720435399
Name:MCANDREWS-MORIN, LISA G (RPH,BCGP,CDOE,CVDOE)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:MCANDREWS-MORIN
Suffix:
Gender:F
Credentials:RPH,BCGP,CDOE,CVDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-0502
Mailing Address - Country:US
Mailing Address - Phone:401-486-8697
Mailing Address - Fax:
Practice Address - Street 1:7 GREENHOUSE RD #265D
Practice Address - Street 2:PHARMACY OUTREACH DEPT. (PER DIEM PRACTICE LOCATION)
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881
Practice Address - Country:US
Practice Address - Phone:401-486-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH03593183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist