Lisa Maria Pettko-Self, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

RP038412L Issued in PA

Practice address

1996 Ewings Mill Rd
Coraopolis, PA 15108-3310

Phone

(412) 269-8605

NPI assigned

Aug 8, 2018

Last updated

Aug 8, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533686400000",
    "number": "1639658941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 HIGHLAND DR",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153175226",
            "telephone_number": "724-470-8550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1996 EWINGS MILL RD",
            "city": "CORAOPOLIS",
            "state": "PA",
            "postal_code": "151083310",
            "telephone_number": "412-269-8605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTKO-SELF",
        "first_name": "LISA",
        "middle_name": "MARIA",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-08",
        "last_updated": "2018-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP-038412-L",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP038412L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Coraopolis, PA
• Providers in Coraopolis, PA by specialty
• Pharmacist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.