Healthcare Provider Details

I. General information

NPI: 1174110399
Provider Name (Legal Business Name): LISA MAE HEYSE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GILL HALL RD
JEFFERSON HILLS PA
15025-3004
US

IV. Provider business mailing address

152 ROCK HAVEN LN
PITTSBURGH PA
15228-1800
US

V. Phone/Fax

Practice location:
  • Phone: 412-653-7566
  • Fax:
Mailing address:
  • Phone: 412-343-0732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP036437R
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: