Healthcare Provider Details

I. General information

NPI: 1659368991
Provider Name (Legal Business Name): LISAMARIE VIVIAN SCHULTZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17316 SHEPHERDSTOWN PIKE
SHARPSBURG MD
21782-1626
US

IV. Provider business mailing address

11753 WOODLEA DR
WAYNESBORO PA
17268-9334
US

V. Phone/Fax

Practice location:
  • Phone: 301-432-7225
  • Fax: 301-432-4423
Mailing address:
  • Phone: 717-765-4295
  • Fax: 301-432-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13380
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: