Provider Demographics
NPI:1063750693
Name:SISK, EVA RENEE (PHARMD)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:RENEE
Last Name:SISK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 MONTCLAIR RD
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2205
Mailing Address - Country:US
Mailing Address - Phone:205-951-6632
Mailing Address - Fax:205-951-6637
Practice Address - Street 1:1325 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2205
Practice Address - Country:US
Practice Address - Phone:205-951-6632
Practice Address - Fax:205-951-6637
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist