Provider Demographics
NPI:1477141208
Name:GEIST, KEITH ROBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ROBERT
Last Name:GEIST
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 CHESTNUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9675
Mailing Address - Country:US
Mailing Address - Phone:724-650-5335
Mailing Address - Fax:
Practice Address - Street 1:524 N 6TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3012
Practice Address - Country:US
Practice Address - Phone:610-374-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARPI010109OtherAUTHORIZATION TO ADMINISTER INJECTABLES