Provider Demographics
NPI:1528168671
Name:BORYSIUK, LYDIA J (MS, RPH)
Entity type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:J
Last Name:BORYSIUK
Suffix:
Gender:F
Credentials:MS, RPH
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:J
Other - Last Name:SEMUSCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RPH
Mailing Address - Street 1:121 DEVONSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3437
Mailing Address - Country:US
Mailing Address - Phone:203-932-5711
Mailing Address - Fax:203-937-4754
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:VA CONNECTICUT HEALTHCARE SYSTEM - PHARMACY OFFICE
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:203-937-4754
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist