Provider Demographics
NPI:1346345790
Name:KISSEL, CHRISTOPHER L (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:KISSEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 MAIN STREET
Mailing Address - Street 2:PO BOX 135
Mailing Address - City:NEW HARMONY
Mailing Address - State:IN
Mailing Address - Zip Code:47631-0135
Mailing Address - Country:US
Mailing Address - Phone:812-682-3044
Mailing Address - Fax:812-682-5244
Practice Address - Street 1:511 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:IN
Practice Address - Zip Code:47631-0135
Practice Address - Country:US
Practice Address - Phone:812-682-3044
Practice Address - Fax:812-682-5244
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1154346385OtherBUSINESS NPI NUMBER (ORGA
IN0235940001Medicare ID - Type Unspecified