=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083423578
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA MCCARTHY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2024
-----------------------------------------------------
Last Update Date | 01/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9093 W HAMPTON DR
-----------------------------------------------------
City | NORTH ROYALTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44133-2877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-577-6018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9093 W HAMPTON DR
-----------------------------------------------------
City | NORTH ROYALTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44133-2877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-577-6018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302416144
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03-3-18300
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------