Provider Demographics
NPI:1669546594
Name:MEYER, JOHN LEE (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LEE
Last Name:MEYER
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 1:85 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-8526
Mailing Address - Country:US
Mailing Address - Phone:518-643-6612
Mailing Address - Fax:
Practice Address - Street 1:10 PLATTSBURGH PLZ
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2205
Practice Address - Country:US
Practice Address - Phone:518-563-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist