Provider Demographics
NPI:1356610513
Name:PISOWICZ, CAROL (RPH)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:PISOWICZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:RYBICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1841 171ST ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2215
Mailing Address - Country:US
Mailing Address - Phone:219-844-5030
Mailing Address - Fax:
Practice Address - Street 1:4445 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46327-1411
Practice Address - Country:US
Practice Address - Phone:219-932-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-17
Last Update Date:2011-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN16014827A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist