Provider Demographics
NPI:1023318698
Name:MEYERS, MARK (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MEYERS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HWY 101
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-7626
Mailing Address - Country:US
Mailing Address - Phone:541-902-1905
Mailing Address - Fax:541-902-1908
Practice Address - Street 1:700 HWY 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-7626
Practice Address - Country:US
Practice Address - Phone:541-902-1905
Practice Address - Fax:541-902-1908
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0006179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist