Provider Demographics
NPI:1215364856
Name:BRISTOL, MEGAN LEELANNEE (PHARM-D)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LEELANNEE
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1243
Mailing Address - Country:US
Mailing Address - Phone:518-481-2270
Mailing Address - Fax:518-481-2485
Practice Address - Street 1:133 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1243
Practice Address - Country:US
Practice Address - Phone:518-481-2270
Practice Address - Fax:518-481-2485
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist