Provider Demographics
NPI:1407132194
Name:KEIL, JOHN THOMAS (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:KEIL
Suffix:
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 1:116 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-1938
Mailing Address - Country:US
Mailing Address - Phone:262-639-3423
Mailing Address - Fax:
Practice Address - Street 1:116 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-1938
Practice Address - Country:US
Practice Address - Phone:262-639-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8240183500000X
CO10923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist