Healthcare Provider Details

I. General information

NPI: 1578733515
Provider Name (Legal Business Name): STEPHEN GORSKI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 TED DR
PINE BUSH NY
12566-7032
US

IV. Provider business mailing address

31 TED DR
PINE BUSH NY
12566-7032
US

V. Phone/Fax

Practice location:
  • Phone: 845-744-4827
  • Fax: 845-744-8948
Mailing address:
  • Phone: 845-744-4827
  • Fax: 845-744-8948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number050478-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: