Provider Demographics
NPI:1033782941
Name:GOEBEL, KERI LECLERE (RPH)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LECLERE
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3965
Mailing Address - Country:US
Mailing Address - Phone:785-235-8796
Mailing Address - Fax:785-235-1939
Practice Address - Street 1:2252 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3965
Practice Address - Country:US
Practice Address - Phone:785-235-8796
Practice Address - Fax:785-235-1939
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12618183500000X
KS12618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist