Healthcare Provider Details

I. General information

NPI: 1063130524
Provider Name (Legal Business Name): CHRISTOPHER RYAN PISZCZATOSKI PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 NW 86TH TER
GAINESVILLE FL
32606-9277
US

IV. Provider business mailing address

1605 NW 42ND ST
GAINESVILLE FL
32605-4666
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-9475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPS57910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: