Healthcare Provider Details

I. General information

NPI: 1548443245
Provider Name (Legal Business Name): HOLLY R SHISHIK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WESTMINSTER DR N
GREENFIELD CENTER NY
12833-1839
US

IV. Provider business mailing address

6 WESTMINSTER DR N
GREENFIELD CENTER NY
12833-1839
US

V. Phone/Fax

Practice location:
  • Phone: 518-893-7190
  • Fax:
Mailing address:
  • Phone: 518-893-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042853
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: