Provider Demographics
NPI:1356491948
Name:GERMAINE, KEITH S (BS)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:S
Last Name:GERMAINE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CHESTNUT WAY
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-2314
Mailing Address - Country:US
Mailing Address - Phone:732-841-8330
Mailing Address - Fax:
Practice Address - Street 1:1183 ENGLISHTOWN RD
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1319
Practice Address - Country:US
Practice Address - Phone:732-723-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01887800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist