Provider Demographics
NPI:1396862660
Name:MEYER, CHRIS JERROD (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:JERROD
Last Name:MEYER
Suffix:
Gender:M
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 1:10469 STATE HIGHWAY 105
Mailing Address - Street 2:
Mailing Address - City:LYLE
Mailing Address - State:MN
Mailing Address - Zip Code:55953-6718
Mailing Address - Country:US
Mailing Address - Phone:507-325-2061
Mailing Address - Fax:507-437-9198
Practice Address - Street 1:1001 18TH AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1890
Practice Address - Country:US
Practice Address - Phone:507-437-9185
Practice Address - Fax:507-437-9198
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117341-5183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist