Provider Demographics
NPI:1063837623
Name:WYSOCKI, EMMA (RDN, PHARMD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:WYSOCKI
Suffix:
Gender:F
Credentials:RDN, PHARMD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:COWIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2916
Practice Address - Country:US
Practice Address - Phone:814-659-9795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000554133VN1004X
MDDX3504133VN1004X
OH03438811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric