Provider Demographics
NPI:1265730501
Name:ISERHOTH, JOHN ANDREW III (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANDREW
Last Name:ISERHOTH
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6638 S SUMMERTON RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MI
Mailing Address - Zip Code:48883-9308
Mailing Address - Country:US
Mailing Address - Phone:989-400-1353
Mailing Address - Fax:
Practice Address - Street 1:117 N MISSION ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1819
Practice Address - Country:US
Practice Address - Phone:989-772-7677
Practice Address - Fax:989-773-0663
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist