Provider Demographics
NPI:1861672107
Name:MALISIEWICZ, ZOFIA (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:ZOFIA
Middle Name:
Last Name:MALISIEWICZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 E MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-1817
Mailing Address - Country:US
Mailing Address - Phone:631-728-2566
Mailing Address - Fax:631-723-2409
Practice Address - Street 1:22 E MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-1817
Practice Address - Country:US
Practice Address - Phone:631-728-2566
Practice Address - Fax:631-723-2409
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist