Provider Demographics
NPI:1194029538
Name:KEEBLER, HOWARD MARSHALL III (RPH)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:MARSHALL
Last Name:KEEBLER
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 1:318 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1514
Mailing Address - Country:US
Mailing Address - Phone:814-486-1191
Mailing Address - Fax:814-486-1195
Practice Address - Street 1:318 E 4TH ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1514
Practice Address - Country:US
Practice Address - Phone:814-486-1191
Practice Address - Fax:814-486-1195
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP062285L183500000X
PAPP410821L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy