Provider Demographics
NPI:1669058061
Name:MYSZ, EDYTA (PHARMD)
Entity type:Individual
Prefix:
First Name:EDYTA
Middle Name:
Last Name:MYSZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EDYTA
Other - Middle Name:
Other - Last Name:KUKLINSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2878 VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8042
Mailing Address - Country:US
Mailing Address - Phone:775-356-9708
Mailing Address - Fax:775-356-9715
Practice Address - Street 1:2878 VISTA BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8042
Practice Address - Country:US
Practice Address - Phone:775-356-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist