Provider Demographics
NPI:1073873592
Name:KISER, JOHN A
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:KISER
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 1:112 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-2448
Mailing Address - Country:US
Mailing Address - Phone:704-857-7951
Mailing Address - Fax:704-857-1000
Practice Address - Street 1:112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-2448
Practice Address - Country:US
Practice Address - Phone:704-857-7951
Practice Address - Fax:704-857-1000
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist