Healthcare Provider Details

I. General information

NPI: 1154890986
Provider Name (Legal Business Name): LISA HEISEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2018
Last Update Date: 11/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 THURMONT BLVD
THURMONT MD
21788-2000
US

IV. Provider business mailing address

239 LONGSTREET DR
GETTYSBURG PA
17325-8919
US

V. Phone/Fax

Practice location:
  • Phone: 301-271-2548
  • Fax:
Mailing address:
  • Phone: 301-908-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19207
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: