Healthcare Provider Details

I. General information

NPI: 1518881796
Provider Name (Legal Business Name): LISA ANN MERTENS CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 S BUSINESS 54
ELDON MO
65026-1786
US

IV. Provider business mailing address

608 E 15TH ST
ELDON MO
65026-2528
US

V. Phone/Fax

Practice location:
  • Phone: 573-393-1863
  • Fax:
Mailing address:
  • Phone: 573-645-6978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2001015917
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: