Provider Demographics
NPI:1952301400
Name:CRIMMINS, KEITH (RPH)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:CRIMMINS
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 1:10924 US ROUTE 11
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ADAMS
Mailing Address - State:NY
Mailing Address - Zip Code:13605-3125
Mailing Address - Country:US
Mailing Address - Phone:315-232-2460
Mailing Address - Fax:315-232-2482
Practice Address - Street 1:10924 US ROUTE 11
Practice Address - Street 2:SUITE 3
Practice Address - City:ADAMS
Practice Address - State:NY
Practice Address - Zip Code:13605-3125
Practice Address - Country:US
Practice Address - Phone:315-232-2460
Practice Address - Fax:315-232-2482
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist