Provider Demographics
NPI:1740895622
Name:PAISLEY, AUSTIN MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:MICHAEL
Last Name:PAISLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 JEFFREY DR
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249-3648
Mailing Address - Country:US
Mailing Address - Phone:570-401-2241
Mailing Address - Fax:
Practice Address - Street 1:31 MULE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5029
Practice Address - Country:US
Practice Address - Phone:732-914-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04111200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist