Provider Demographics
NPI:1386885911
Name:PISKOROWSKI, STANLEY MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:MICHAEL
Last Name:PISKOROWSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4101
Mailing Address - Country:US
Mailing Address - Phone:716-693-5272
Mailing Address - Fax:
Practice Address - Street 1:1066 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2720
Practice Address - Country:US
Practice Address - Phone:716-694-0323
Practice Address - Fax:716-693-1506
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18Medicaid