Provider Demographics
NPI:1659782357
Name:HART, GLORIA SARA (RPH)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:SARA
Last Name:HART
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 1:6001 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-4302
Mailing Address - Country:US
Mailing Address - Phone:248-889-6810
Mailing Address - Fax:
Practice Address - Street 1:6001 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48383-4302
Practice Address - Country:US
Practice Address - Phone:248-889-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020233591835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy