Provider Demographics
NPI:1649384561
Name:KASISKY ENTERPRISES INC
Entity Type:Organization
Organization Name:KASISKY ENTERPRISES INC
Other - Org Name:EAGLESCRIPTS APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:KASISKY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-349-9170
Mailing Address - Street 1:401 NORTH 4TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2026
Mailing Address - Country:US
Mailing Address - Phone:724-349-9170
Mailing Address - Fax:724-349-9182
Practice Address - Street 1:401 NORTH 4TH ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2026
Practice Address - Country:US
Practice Address - Phone:724-349-9170
Practice Address - Fax:724-349-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412735L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3943304OtherNCPDP
PA1009833820001Medicaid
5813730001Medicare NSC