Provider Demographics
NPI:1285179432
Name:SRIVASTAVA, ABHISHEK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ABHISHEK
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TOP ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-1905
Mailing Address - Country:US
Mailing Address - Phone:401-919-6577
Mailing Address - Fax:
Practice Address - Street 1:524 BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1154
Practice Address - Country:US
Practice Address - Phone:845-794-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060063183500000X
CT0013185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist