Provider Demographics
NPI:1821325374
Name:KISTLER, PETER BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:BRUCE
Last Name:KISTLER
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 1:439 MARKET ST
Mailing Address - Street 2:P.O. BOX 583
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2335
Mailing Address - Country:US
Mailing Address - Phone:570-286-6711
Mailing Address - Fax:570-286-4611
Practice Address - Street 1:439 MARKET ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2335
Practice Address - Country:US
Practice Address - Phone:570-286-6711
Practice Address - Fax:570-286-4611
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030105L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist