Provider Demographics
NPI:1710963632
Name:KISZKIEL, JOHN A II (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:KISZKIEL
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLOVER LN
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-3244
Mailing Address - Country:US
Mailing Address - Phone:860-572-8016
Mailing Address - Fax:860-572-8016
Practice Address - Street 1:1 PLOVER LN
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-3244
Practice Address - Country:US
Practice Address - Phone:860-572-8016
Practice Address - Fax:860-572-8016
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist