Healthcare Provider Details

I. General information

NPI: 1356659015
Provider Name (Legal Business Name): LISA MICHELLE HARTMAN RP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 N MAIN RD
VINELAND NJ
08360-8266
US

IV. Provider business mailing address

970 N MAIN RD
VINELAND NJ
08360-8266
US

V. Phone/Fax

Practice location:
  • Phone: 856-563-1599
  • Fax: 856-563-0282
Mailing address:
  • Phone: 856-563-1599
  • Fax: 856-563-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02127600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: