Provider Demographics
NPI:1962073171
Name:ACCARDI, ALYSHIA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALYSHIA
Middle Name:
Last Name:ACCARDI
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 1:234 KENILWORTH DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1717
Mailing Address - Country:US
Mailing Address - Phone:815-319-0107
Mailing Address - Fax:
Practice Address - Street 1:3929 N MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5600
Practice Address - Country:US
Practice Address - Phone:815-633-9157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist