Provider Demographics
NPI:1780337725
Name:PRISER, MYRA (RPH)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:PRISER
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 1:120 NORTH OAK STREET
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521
Mailing Address - Country:US
Mailing Address - Phone:630-856-3966
Mailing Address - Fax:630-856-3939
Practice Address - Street 1:120 NORTH OAK STREET
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-856-3966
Practice Address - Fax:630-856-3939
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510398661835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care