Provider Demographics
NPI:1225213168
Name:NEUSTADT, RISA SHARON (RPH)
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:SHARON
Last Name:NEUSTADT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CRYSTAL FARM RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2863
Mailing Address - Country:US
Mailing Address - Phone:845-651-1589
Mailing Address - Fax:845-651-1599
Practice Address - Street 1:5 CRYSTAL FARM RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-2863
Practice Address - Country:US
Practice Address - Phone:845-651-1589
Practice Address - Fax:845-651-1599
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist