Healthcare Provider Details

I. General information

NPI: 1649552647
Provider Name (Legal Business Name): MR. LOUIS PISANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EAGLEVIEW BLVD
EXTON PA
19341-1157
US

IV. Provider business mailing address

209 GREEN VALLEY RD
EXTON PA
19341-2457
US

V. Phone/Fax

Practice location:
  • Phone: 610-594-3567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP030209L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: