Healthcare Provider Details

I. General information

NPI: 1104197250
Provider Name (Legal Business Name): SANDRA KILLGORE MEISLER PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2012
Last Update Date: 01/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 MAIN ST
HAYNESVILLE LA
71038-4907
US

IV. Provider business mailing address

1909 MAIN ST
HAYNESVILLE LA
71038-4907
US

V. Phone/Fax

Practice location:
  • Phone: 318-624-1122
  • Fax: 318-624-3343
Mailing address:
  • Phone: 318-624-1122
  • Fax: 318-624-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8540
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: