Provider Demographics
NPI:1457693483
Name:MISSLER, EDWARD ALFRED (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALFRED
Last Name:MISSLER
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 1:1001 NOBLE ST
Mailing Address - Street 2:PROFESSIONAL PHARMACY
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4922
Mailing Address - Country:US
Mailing Address - Phone:907-452-2556
Mailing Address - Fax:907-451-8314
Practice Address - Street 1:1001 NOBLE ST
Practice Address - Street 2:PROFESSIONAL PHARMACY
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4922
Practice Address - Country:US
Practice Address - Phone:907-452-2556
Practice Address - Fax:907-451-8314
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist