Provider Demographics
NPI:1417630484
Name:BUBNIAK, ALYSSA KAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:KAY
Last Name:BUBNIAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-1218
Mailing Address - Country:US
Mailing Address - Phone:607-535-3125
Mailing Address - Fax:
Practice Address - Street 1:515 E 4TH ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1218
Practice Address - Country:US
Practice Address - Phone:607-535-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist