Provider Demographics
NPI:1083289714
Name:KISHFY, GARY STEVEN
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:STEVEN
Last Name:KISHFY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MARK DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4007
Mailing Address - Country:US
Mailing Address - Phone:401-440-3936
Mailing Address - Fax:
Practice Address - Street 1:CVS #00269
Practice Address - Street 2:583 TAUNTON AVE
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914
Practice Address - Country:US
Practice Address - Phone:401-434-2993
Practice Address - Fax:401-438-3210
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI3054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist