Healthcare Provider Details

I. General information

NPI: 1306761150
Provider Name (Legal Business Name): LISA DANDANEAU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 GREY LAG WAY
LEXINGTON KY
40509-2477
US

IV. Provider business mailing address

613 CHERRY TRACE DR
RICHMOND KY
40475-8478
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-0526
  • Fax:
Mailing address:
  • Phone: 859-263-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number011989
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: