Healthcare Provider Details

I. General information

NPI: 1144495631
Provider Name (Legal Business Name): LISA ANNE SALANDRIA PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 HIGH STREET
MT HOLLY NJ
08060
US

IV. Provider business mailing address

531 HIGH STREET
MT HOLLY NJ
08060
US

V. Phone/Fax

Practice location:
  • Phone: 609-702-1780
  • Fax:
Mailing address:
  • Phone: 609-702-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42699
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RIO2957400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452278
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: