Provider Demographics
NPI:1053503086
Name:KESLER, ALLA
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:KESLER
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 1:50 BROADLAWN PARK
Mailing Address - Street 2:APT 310
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1234
Mailing Address - Country:US
Mailing Address - Phone:617-665-1355
Mailing Address - Fax:
Practice Address - Street 1:50 BROADLAWN PARK
Practice Address - Street 2:APT 310
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3524
Practice Address - Country:US
Practice Address - Phone:617-665-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist