Healthcare Provider Details

I. General information

NPI: 1043873045
Provider Name (Legal Business Name): HOWARD SAMUEL KREISLER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W FLETCHER ST
HAXTUN CO
80731-2737
US

IV. Provider business mailing address

3655 S VERBENA ST APT D202
DENVER CO
80237-1599
US

V. Phone/Fax

Practice location:
  • Phone: 970-774-6979
  • Fax:
Mailing address:
  • Phone: 954-496-1493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0022275
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: