Provider Demographics
NPI:1467574426
Name:KLISHEVICH, PATRICIA A (RPH FASCP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:KLISHEVICH
Suffix:
Gender:F
Credentials:RPH FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 LOUIS JAMES CT
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-3357
Mailing Address - Country:US
Mailing Address - Phone:610-364-0760
Mailing Address - Fax:
Practice Address - Street 1:111 RUTHAR DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-8025
Practice Address - Country:US
Practice Address - Phone:800-727-0123
Practice Address - Fax:800-775-3275
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA10001715183500000X
PARP028610L183500000X
MD16185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist