Provider Demographics
NPI:1902074370
Name:BLESSON, LISA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA MARIE
Middle Name:
Last Name:BLESSON
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 1:206 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2916
Mailing Address - Country:US
Mailing Address - Phone:973-877-3641
Mailing Address - Fax:
Practice Address - Street 1:206 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2916
Practice Address - Country:US
Practice Address - Phone:973-877-3641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048746183500000X
NJ28RI02725400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist