Provider Demographics
NPI:1497188064
Name:SISKAVICH, KIMBERLY A (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:A
Last Name:SISKAVICH
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 1:19 CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6553
Mailing Address - Country:US
Mailing Address - Phone:518-562-3565
Mailing Address - Fax:518-562-3859
Practice Address - Street 1:19 CENTRE DR
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6553
Practice Address - Country:US
Practice Address - Phone:518-562-3565
Practice Address - Fax:518-562-3859
Is Sole Proprietor?:No
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist