Basic Information
| Provider Information | |||||||||
| NPI: | 1487012944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALTZMAN | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 VAN BUREN ST | ||||||||
| Address2: | |||||||||
| City: | FOSTORIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448301534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194357734 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 501 VAN BUREN ST | ||||||||
| Address2: | |||||||||
| City: | FOSTORIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448301534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194357734 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2016 | ||||||||
| LastUpdateDate: | 01/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 03221399 | OH | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.