Provider Demographics
NPI:1427564582
Name:CHEIMAN, KEVIN STUART (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:STUART
Last Name:CHEIMAN
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 1:5450 SOUTH AVE NW
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-9335
Mailing Address - Country:US
Mailing Address - Phone:561-283-9387
Mailing Address - Fax:
Practice Address - Street 1:1815 4TH ST
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-2210
Practice Address - Country:US
Practice Address - Phone:503-842-5934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16286183500000X
OR00162861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist