Healthcare Provider Details

I. General information

NPI: 1255253308
Provider Name (Legal Business Name): SORA VYSOTSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 LAURELHURST RD
UNIVERSITY HEIGHTS OH
44118-4612
US

IV. Provider business mailing address

2512 LAURELHURST RD
UNIVERSITY HEIGHTS OH
44118-4612
US

V. Phone/Fax

Practice location:
  • Phone: 978-578-7150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberI-062301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: