Provider Demographics
NPI:1497061444
Name:ECKERT, LISA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ECKERT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8721 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:PORT NORRIS
Mailing Address - State:NJ
Mailing Address - Zip Code:08349-3419
Mailing Address - Country:US
Mailing Address - Phone:609-319-5019
Mailing Address - Fax:
Practice Address - Street 1:907 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-3762
Practice Address - Country:US
Practice Address - Phone:856-825-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI02285200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist