Provider Demographics
NPI:1922609387
Name:KOVACS, KEITH ANDREW (RPH)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ANDREW
Last Name:KOVACS
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 1:2485 POSSUM RUN RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-9447
Mailing Address - Country:US
Mailing Address - Phone:419-756-7177
Mailing Address - Fax:419-756-7205
Practice Address - Street 1:2485 POSSUM RUN RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-9447
Practice Address - Country:US
Practice Address - Phone:419-756-7177
Practice Address - Fax:419-756-7205
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist