Healthcare Provider Details

I. General information

NPI: 1366759367
Provider Name (Legal Business Name): MICHAEL STANLEY SYSKA PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PERRY HWY
PITTSBURGH PA
15229-1820
US

IV. Provider business mailing address

2427 ROLLING FARMS RD
GLENSHAW PA
15116-2563
US

V. Phone/Fax

Practice location:
  • Phone: 412-931-7751
  • Fax:
Mailing address:
  • Phone: 412-427-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444246
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: