Provider Demographics
NPI:1093319451
Name:GEISLER, DALTON
Entity Type:Individual
Prefix:
First Name:DALTON
Middle Name:
Last Name:GEISLER
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 1:2990 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3266
Mailing Address - Country:US
Mailing Address - Phone:217-877-1703
Mailing Address - Fax:217-876-7540
Practice Address - Street 1:2990 N MONROE ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3266
Practice Address - Country:US
Practice Address - Phone:217-877-1703
Practice Address - Fax:217-876-7540
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist