Provider Demographics
NPI:1972850485
Name:LISEWSKI, STAN PETER (RPH)
Entity Type:Individual
Prefix:MR
First Name:STAN
Middle Name:PETER
Last Name:LISEWSKI
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 1:4 KERSKI DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1170
Mailing Address - Country:US
Mailing Address - Phone:203-881-0758
Mailing Address - Fax:
Practice Address - Street 1:4 KERSKI DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1170
Practice Address - Country:US
Practice Address - Phone:203-881-0758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist