Provider Demographics
NPI:1407957053
Name:GUISINGER, SCOTT T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:GUISINGER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 BLACK RIVER BLVD N
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2425
Mailing Address - Country:US
Mailing Address - Phone:315-339-0648
Mailing Address - Fax:315-337-5303
Practice Address - Street 1:1717 BLACK RIVER BLVD N
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2425
Practice Address - Country:US
Practice Address - Phone:315-339-0648
Practice Address - Fax:315-337-5303
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02742496Medicaid