MEDICARE: CARISSA ANN HART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP454158	PA

General Provider Information

NPI Number	:	1205468121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA ANN HART

Provider Business Mailing Address
First Line	:	114 SHOEMAKER ST
Second Line	:
City	:	DUNMORE
State	:	PA
Zip	:	18512-2734
Country	:	US
Telephone Number	:	570-241-3593
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 VIEWMONT DR
Second Line	:
City	:	DICKSON CITY
State	:	PA
Zip	:	18519-1663
Country	:	US
Telephone Number	:	570-558-7696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2020
Last Update Date	:	02/08/2020

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Directions to “ CARISSA ANN HART ” Practice Location

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