Provider Demographics
NPI:1871767624
Name:FLAHERTY, LISA CELIA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CELIA
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1064
Mailing Address - Country:US
Mailing Address - Phone:302-561-0707
Mailing Address - Fax:302-376-1378
Practice Address - Street 1:455 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1064
Practice Address - Country:US
Practice Address - Phone:302-561-0707
Practice Address - Fax:302-376-1378
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist