Provider Demographics
NPI:1598740433
Name:NEIDIG, KEVIN H (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:H
Last Name:NEIDIG
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 1:3389 TABOR RIDGE RD NE
Mailing Address - Street 2:
Mailing Address - City:MINERAL CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44656-9313
Mailing Address - Country:US
Mailing Address - Phone:330-602-9473
Mailing Address - Fax:330-343-2442
Practice Address - Street 1:130 1/2 W HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-3802
Practice Address - Country:US
Practice Address - Phone:330-365-1526
Practice Address - Fax:330-365-1513
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-14789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist