Provider Demographics
NPI:1730789405
Name:HRYTSYSHYN, ALIAKSANDR (PARMD)
Entity type:Individual
Prefix:DR
First Name:ALIAKSANDR
Middle Name:
Last Name:HRYTSYSHYN
Suffix:
Gender:M
Credentials:PARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MERRITT BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-2107
Mailing Address - Country:US
Mailing Address - Phone:410-631-1280
Mailing Address - Fax:844-411-6333
Practice Address - Street 1:1400 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-2107
Practice Address - Country:US
Practice Address - Phone:410-631-1280
Practice Address - Fax:844-411-6333
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist