Provider Demographics
NPI:1598087322
Name:ZIERKE, KEITH J
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:J
Last Name:ZIERKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10331 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-6472
Mailing Address - Country:US
Mailing Address - Phone:515-225-2694
Mailing Address - Fax:515-222-0813
Practice Address - Street 1:10331 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6472
Practice Address - Country:US
Practice Address - Phone:515-225-2694
Practice Address - Fax:515-222-0813
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist