Provider Demographics
NPI:1497063960
Name:KISER, SHEILA GHANT (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:GHANT
Last Name:KISER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 S TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3325
Mailing Address - Country:US
Mailing Address - Phone:704-504-2346
Mailing Address - Fax:704-504-2350
Practice Address - Street 1:8120 S TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3325
Practice Address - Country:US
Practice Address - Phone:704-504-2346
Practice Address - Fax:704-504-2350
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6829183500000X
NC10370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0609183Medicaid
3436450OtherNABP