Healthcare Provider Details

I. General information

NPI: 1124398367
Provider Name (Legal Business Name): MICHELE KISLAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 12/28/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 33100 BOX LRMC
APO AE
09180-3100
US

IV. Provider business mailing address

UNIT 33100 BOX LRMC
APO AE
09180-3100
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-5222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24986
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 60563151
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number24986
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60563151
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: