Provider Demographics
NPI:1811776487
Name:SINISKO, CARSON JAMES (PHARMACY INTERN)
Entity type:Individual
Prefix:MR
First Name:CARSON
Middle Name:JAMES
Last Name:SINISKO
Suffix:
Gender:M
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 SHADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-7111
Mailing Address - Country:US
Mailing Address - Phone:570-202-6344
Mailing Address - Fax:
Practice Address - Street 1:237 S MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-2071
Practice Address - Country:US
Practice Address - Phone:570-474-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPI125587183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician