Provider Demographics
NPI:1619566395
Name:CISZEK, CHRISTOPHER ERVIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ERVIN
Last Name:CISZEK
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 1:5990 RICHMOND HWY APT 602
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2748
Mailing Address - Country:US
Mailing Address - Phone:540-415-2023
Mailing Address - Fax:
Practice Address - Street 1:5870 KINGSTOWNE CTR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5704
Practice Address - Country:US
Practice Address - Phone:703-313-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist