Provider Demographics
NPI:1699377911
Name:MEISETSCHLEAGER, JUSTIN
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:MEISETSCHLEAGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 FM 1680
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:TX
Mailing Address - Zip Code:77975-4865
Mailing Address - Country:US
Mailing Address - Phone:361-798-6772
Mailing Address - Fax:
Practice Address - Street 1:1202 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-2124
Practice Address - Country:US
Practice Address - Phone:361-275-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist