Provider Demographics
NPI:1821575176
Name:KEISER, DONALD MATSON III (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MATSON
Last Name:KEISER
Suffix:III
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 1:139 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAXEYS
Mailing Address - State:GA
Mailing Address - Zip Code:30671
Mailing Address - Country:US
Mailing Address - Phone:706-424-3484
Mailing Address - Fax:
Practice Address - Street 1:6380 LAKE OCONEE PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642
Practice Address - Country:US
Practice Address - Phone:706-454-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist