Provider Demographics
NPI:1598876609
Name:KEELEY, JON ROBERT (RPH, MS)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:ROBERT
Last Name:KEELEY
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 HALL ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9485
Mailing Address - Country:US
Mailing Address - Phone:855-729-3939
Mailing Address - Fax:855-879-4949
Practice Address - Street 1:6920 HALL ST
Practice Address - Street 2:SUITE #1
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9485
Practice Address - Country:US
Practice Address - Phone:855-729-3939
Practice Address - Fax:855-879-4949
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-11-4983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist