Healthcare Provider Details

I. General information

NPI: 1912077207
Provider Name (Legal Business Name): DONALD K CISLER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 W MAIN ST
FREMONT MI
49412-1136
US

IV. Provider business mailing address

6859 WILCOX AVE
FREMONT MI
49412-9241
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-2720
  • Fax: 231-924-1281
Mailing address:
  • Phone: 231-924-3697
  • Fax: 231-924-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302024665
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: