Provider Demographics
NPI:1841590650
Name:TAFT, KEITH JR
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:TAFT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5146 STEVENS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1019
Mailing Address - Country:US
Mailing Address - Phone:408-556-0614
Mailing Address - Fax:408-556-0620
Practice Address - Street 1:5146 STEVENS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-1019
Practice Address - Country:US
Practice Address - Phone:408-556-0614
Practice Address - Fax:408-556-0620
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist