Provider Demographics
NPI:1598849622
Name:WILLIAM E KEUPER
Entity Type:Organization
Organization Name:WILLIAM E KEUPER
Other - Org Name:NORTHERN HILLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEUPER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-931-2525
Mailing Address - Street 1:1829 W GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-4848
Mailing Address - Country:US
Mailing Address - Phone:513-931-2525
Mailing Address - Fax:513-931-4635
Practice Address - Street 1:1829 W GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4848
Practice Address - Country:US
Practice Address - Phone:513-931-2525
Practice Address - Fax:513-931-4635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0200866003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00316100Medicaid
3600120OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0440610001Medicare NSC