Provider Demographics
NPI:1801231725
Name:PISKADLO, BRYAN SCOTT (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:SCOTT
Last Name:PISKADLO
Suffix:
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 1:11-12 SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5722
Mailing Address - Country:US
Mailing Address - Phone:201-797-0006
Mailing Address - Fax:201-797-0007
Practice Address - Street 1:11-12 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5722
Practice Address - Country:US
Practice Address - Phone:201-797-0006
Practice Address - Fax:201-797-0007
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02225700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist