Provider Demographics
NPI:1619421054
Name:HABOWSKI, KEITH THOMAS
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:THOMAS
Last Name:HABOWSKI
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 1:4989 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3892
Mailing Address - Country:US
Mailing Address - Phone:989-791-3088
Mailing Address - Fax:
Practice Address - Street 1:2901 CENTER AVE
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-1703
Practice Address - Country:US
Practice Address - Phone:989-894-4832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-14
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist