1679398911 NPI number — DR. BENJAMIN ROSS KISER PHARMD

Table of content: DR. BENJAMIN ROSS KISER PHARMD (NPI 1679398911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679398911 NPI number — DR. BENJAMIN ROSS KISER PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KISER
Provider First Name:
BENJAMIN
Provider Middle Name:
ROSS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679398911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 446
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KING
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27021-0446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-414-6186
Provider Business Mailing Address Fax Number:
336-983-2933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
533 S. MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-983-3118
Provider Business Practice Location Address Fax Number:
336-983-2933
Provider Enumeration Date:
11/21/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  21718 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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