Provider Demographics
NPI:1811877426
Name:FISK, FAITH
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:FISK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 TROLLEY LINE RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-5234
Mailing Address - Country:US
Mailing Address - Phone:315-396-5303
Mailing Address - Fax:
Practice Address - Street 1:119 MARKET ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURGH
Practice Address - State:NY
Practice Address - Zip Code:12122-6432
Practice Address - Country:US
Practice Address - Phone:518-827-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty