Provider Demographics
NPI:1649577784
Name:KEIMACH, BRIAN MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:KEIMACH
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 1:266 BEVERLY PL
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3801
Mailing Address - Country:US
Mailing Address - Phone:803-466-6714
Mailing Address - Fax:847-368-6588
Practice Address - Street 1:107 WESTPARK BLVD
Practice Address - Street 2:SUITE #120
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3871
Practice Address - Country:US
Practice Address - Phone:803-772-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23654183500000X
SC12378183500000X
IL051-293153183500000X
NV13738183500000X
OH03-1-24484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist