Provider Demographics
NPI:1780355735
Name:KEIMACH, JEFF A (PHARMD)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:A
Last Name:KEIMACH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11195 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1720
Mailing Address - Country:US
Mailing Address - Phone:949-677-0959
Mailing Address - Fax:
Practice Address - Street 1:11195 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1720
Practice Address - Country:US
Practice Address - Phone:949-677-0959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV18017OtherPHARMACY LICENSE
CA39457OtherPHARMACY LICENSE