Provider Demographics
NPI:1659976629
Name:BARHYDT, KEEGAN (RPH)
Entity Type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:BARHYDT
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 1:101 W US HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:IN
Mailing Address - Zip Code:46767-1732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 W US HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:IN
Practice Address - Zip Code:46767-1732
Practice Address - Country:US
Practice Address - Phone:260-894-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020148A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist