Provider Demographics
NPI:1063027969
Name:KEISEL, KURT (PHARMD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:KEISEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 HILLCREST CIR
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-5527
Mailing Address - Country:US
Mailing Address - Phone:435-851-7889
Mailing Address - Fax:
Practice Address - Street 1:949 W GRASSLAND DR
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2753
Practice Address - Country:US
Practice Address - Phone:801-492-1106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5556489-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist