Healthcare Provider Details

I. General information

NPI: 1902913437
Provider Name (Legal Business Name): LISA M DONNINI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4448 STATE HIGHWAY 30
MIDDLEBURGH NY
12122
US

IV. Provider business mailing address

22 UPHAMS CORNERS RD
EAST NASSAU NY
12062-2530
US

V. Phone/Fax

Practice location:
  • Phone: 518-827-4488
  • Fax:
Mailing address:
  • Phone: 518-766-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: