Stan Peter Lisewski, RPH
Individual provider Active NPI Pharmacist · Oxford, CT
NPI 1972850485 · NPPES record last updated Aug 14, 2012
Key facts
- NPI
- 1972850485
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0617 (CT)
- Practice address
- 4 Kerski Dr
Oxford, CT 06478-1170 - Phone
- (203) 881-0758
- NPI assigned
- Aug 14, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0617 | CT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0617 | CT | Yes |
Addresses
Primary practice location
4 Kerski Dr
Oxford, CT 06478-1170
Mailing address
4 Kerski Dr
Oxford, CT 06478-1170
Phone (203) 881-0758
Other providers in Oxford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.