Provider Demographics
NPI:1336805019
Name:KIES, RHEANNA
Entity Type:Individual
Prefix:
First Name:RHEANNA
Middle Name:
Last Name:KIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 RED CEDAR DR APT 3C
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-7548
Mailing Address - Country:US
Mailing Address - Phone:397-710-5154
Mailing Address - Fax:
Practice Address - Street 1:10 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1933
Practice Address - Country:US
Practice Address - Phone:937-898-8829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist