Provider Demographics
NPI:1346305836
Name:ESSLER, KIM L
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:L
Last Name:ESSLER
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:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540-1206
Mailing Address - Country:US
Mailing Address - Phone:701-463-2575
Mailing Address - Fax:701-463-2311
Practice Address - Street 1:21 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540
Practice Address - Country:US
Practice Address - Phone:701-463-2242
Practice Address - Fax:701-463-2311
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4191183500000X
TX28456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28456OtherSTATE PHARMACY LICENSE #
ND4191OtherSTATE PHARMACY LICENSE #