Provider Demographics
NPI:1699318279
Name:MEYERS, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 N OAKS LN NW
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:56332-8344
Mailing Address - Country:US
Mailing Address - Phone:320-333-5530
Mailing Address - Fax:
Practice Address - Street 1:11 CENTRAL AVE S
Practice Address - Street 2:
Practice Address - City:ELBOW LAKE
Practice Address - State:MN
Practice Address - Zip Code:56531-4116
Practice Address - Country:US
Practice Address - Phone:218-685-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist