Provider Demographics
NPI:1629354311
Name:KEIDSER, JON ERIK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:ERIK
Last Name:KEIDSER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6508
Mailing Address - Country:US
Mailing Address - Phone:435-879-5165
Mailing Address - Fax:435-879-5171
Practice Address - Street 1:1849 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6508
Practice Address - Country:US
Practice Address - Phone:435-879-5165
Practice Address - Fax:435-879-5171
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5227591-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist