Provider Demographics
NPI:1427040807
Name:KEYES, LON NICHOLAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:LON
Middle Name:NICHOLAS
Last Name:KEYES
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 1:416 E MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-2015
Mailing Address - Country:US
Mailing Address - Phone:260-665-2141
Mailing Address - Fax:260-665-7888
Practice Address - Street 1:416 E MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2015
Practice Address - Country:US
Practice Address - Phone:260-665-2141
Practice Address - Fax:260-665-7888
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016064A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist