Provider Demographics
NPI:1902913437
Name:DONNINI, LISA M (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:DONNINI
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 1:22 UPHAMS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:EAST NASSAU
Mailing Address - State:NY
Mailing Address - Zip Code:12062-2530
Mailing Address - Country:US
Mailing Address - Phone:518-766-5143
Mailing Address - Fax:
Practice Address - Street 1:4448 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:MIDDLEBURGH
Practice Address - State:NY
Practice Address - Zip Code:12122
Practice Address - Country:US
Practice Address - Phone:518-827-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist