Provider Demographics
NPI:1386025211
Name:KEIL, STUART ROSS (R PH)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:ROSS
Last Name:KEIL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1521
Mailing Address - Country:US
Mailing Address - Phone:973-733-2113
Mailing Address - Fax:973-744-2691
Practice Address - Street 1:732 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1521
Practice Address - Country:US
Practice Address - Phone:973-733-2113
Practice Address - Fax:973-744-2691
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R100172300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist