Provider Demographics
NPI:1619572666
Name:MUKINA, KALEB THOMAS (RPH)
Entity Type:Individual
Prefix:DR
First Name:KALEB
Middle Name:THOMAS
Last Name:MUKINA
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 1:1219 HIGHLAND ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3204
Mailing Address - Country:US
Mailing Address - Phone:814-490-7944
Mailing Address - Fax:
Practice Address - Street 1:815 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1464
Practice Address - Country:US
Practice Address - Phone:614-300-7205
Practice Address - Fax:800-685-5308
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist