Provider Demographics
NPI:1235497488
Name:MCCUISTON, ELISE ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:ANNE
Last Name:MCCUISTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:213 N WALNUT ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-4947
Mailing Address - Country:US
Mailing Address - Phone:812-305-4771
Mailing Address - Fax:812-353-3497
Practice Address - Street 1:451 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5004
Practice Address - Country:US
Practice Address - Phone:812-353-3498
Practice Address - Fax:812-353-3497
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023593A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist