Provider Demographics
NPI:1376143776
Name:KLEMAN, KEITH ROBERT
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ROBERT
Last Name:KLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 HAVEMANN RD
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-9300
Mailing Address - Country:US
Mailing Address - Phone:419-586-6177
Mailing Address - Fax:419-586-1926
Practice Address - Street 1:1950 HAVEMANN RD
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-9300
Practice Address - Country:US
Practice Address - Phone:419-586-6177
Practice Address - Fax:419-586-1926
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-16834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist