Provider Demographics
NPI:1043583255
Name:ISSLER, DUSTIN LEE
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:LEE
Last Name:ISSLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 N NEWPORT HWY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1219
Mailing Address - Country:US
Mailing Address - Phone:509-466-7414
Mailing Address - Fax:509-466-0546
Practice Address - Street 1:9520 N NEWPORT HWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1219
Practice Address - Country:US
Practice Address - Phone:509-466-7414
Practice Address - Fax:509-466-0546
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP00053533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist