Healthcare Provider Details

I. General information

NPI: 1619896115
Provider Name (Legal Business Name): ALISA LARA MAHINAY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

32000 N ROCKWELL DR
LAKEMOOR IL
60051-6604
US

V. Phone/Fax

Practice location:
  • Phone: 224-656-7430
  • Fax:
Mailing address:
  • Phone: 224-656-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23484-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: