MEDICARE: MRS. LISA MARIE MCCORMICK R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	4286	ND

General Provider Information

NPI Number	:	1831364116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE MCCORMICK R.PH.

Provider Business Mailing Address
First Line	:	1140 E BISMARCK EXPY
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-6603
Country	:	US
Telephone Number	:	701-255-7220
Fax Number	:	701-255-6029

Provider Business Practice Location Address
First Line	:	1140 E BISMARCK EXPY
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-6603
Country	:	US
Telephone Number	:	701-255-7220
Fax Number	:	701-255-6029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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