Provider Demographics
NPI:1114523594
Name:KISHAR, ALI M
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:M
Last Name:KISHAR
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 1:1205 OVERLOOK RD APT 2
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-6125
Mailing Address - Country:US
Mailing Address - Phone:610-390-2613
Mailing Address - Fax:
Practice Address - Street 1:1205 OVERLOOK RD APT 2
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-6125
Practice Address - Country:US
Practice Address - Phone:610-390-2613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist