Provider Demographics
NPI:1770641086
Name:PISTORINO, THERESA LOUISE (RPH, CGP, BCPS)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LOUISE
Last Name:PISTORINO
Suffix:
Gender:F
Credentials:RPH, CGP, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1716
Mailing Address - Country:US
Mailing Address - Phone:845-486-4109
Mailing Address - Fax:
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-6179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0484141835G0303X
NY31007901835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric