Provider Demographics
NPI:1427591882
Name:GATITSKIY, VITA
Entity Type:Individual
Prefix:
First Name:VITA
Middle Name:
Last Name:GATITSKIY
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 1:5 SANDY POINTE DR APT H
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4649
Mailing Address - Country:US
Mailing Address - Phone:518-727-8476
Mailing Address - Fax:
Practice Address - Street 1:2027 DOUBLEDAY AVE
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1243
Practice Address - Country:US
Practice Address - Phone:518-727-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist