Provider Demographics
NPI:1770847097
Name:SKALISKY, STEVE
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:SKALISKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 OAK CT
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2426
Mailing Address - Country:US
Mailing Address - Phone:661-746-6732
Mailing Address - Fax:
Practice Address - Street 1:278 OAK CT
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2426
Practice Address - Country:US
Practice Address - Phone:661-746-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist