Provider Demographics
NPI:1053595801
Name:RYSZKA, LISA MARIE (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:RYSZKA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 GREENHILL TER
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4118
Mailing Address - Country:US
Mailing Address - Phone:716-674-2717
Mailing Address - Fax:
Practice Address - Street 1:57 GREENHILL TER
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4118
Practice Address - Country:US
Practice Address - Phone:716-674-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist