Provider Demographics
NPI:1407021298
Name:GISO, MARIESA
Entity Type:Individual
Prefix:
First Name:MARIESA
Middle Name:
Last Name:GISO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 ALTAMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-2909
Mailing Address - Country:US
Mailing Address - Phone:518-356-1131
Mailing Address - Fax:518-356-0373
Practice Address - Street 1:1400 ALTAMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-2909
Practice Address - Country:US
Practice Address - Phone:518-356-1131
Practice Address - Fax:518-356-0373
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist