Provider Demographics
NPI:1104197250
Name:MEISLER, SANDRA KILLGORE (PH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KILLGORE
Last Name:MEISLER
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAYNESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71038-4907
Mailing Address - Country:US
Mailing Address - Phone:318-624-1122
Mailing Address - Fax:318-624-3343
Practice Address - Street 1:1909 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAYNESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71038-4907
Practice Address - Country:US
Practice Address - Phone:318-624-1122
Practice Address - Fax:318-624-3343
Is Sole Proprietor?:No
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist