Provider Demographics
NPI:1962629956
Name:HISH, STANSISLAV (RPH)
Entity Type:Individual
Prefix:
First Name:STANSISLAV
Middle Name:
Last Name:HISH
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 1:12 SCHOOL RD W
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1507
Mailing Address - Country:US
Mailing Address - Phone:732-617-6060
Mailing Address - Fax:732-719-2323
Practice Address - Street 1:12 SCHOOL RD W
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1507
Practice Address - Country:US
Practice Address - Phone:732-617-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43948183500000X
NJ25894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist