Provider Demographics
NPI:1033706932
Name:KERYESKI, ANGELA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:KERYESKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:KEPPLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9525 KENWOOD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6177
Mailing Address - Country:US
Mailing Address - Phone:513-791-7373
Mailing Address - Fax:
Practice Address - Street 1:9525 KENWOOD RD STE 1
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6177
Practice Address - Country:US
Practice Address - Phone:513-791-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-25
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03330985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist