Provider Demographics
NPI:1386197473
Name:KEATING, JONATHAN (PHAMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:KEATING
Suffix:
Gender:M
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3808
Mailing Address - Country:US
Mailing Address - Phone:970-945-7403
Mailing Address - Fax:
Practice Address - Street 1:1412 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3808
Practice Address - Country:US
Practice Address - Phone:970-945-7403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist