Provider Demographics
NPI:1932185071
Name:NUSBAUM, KEITH A (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:A
Last Name:NUSBAUM
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 1:1535 GRANT BLVD
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1314
Mailing Address - Country:US
Mailing Address - Phone:419-422-6343
Mailing Address - Fax:419-422-6343
Practice Address - Street 1:139 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DESHLER
Practice Address - State:OH
Practice Address - Zip Code:43516-1159
Practice Address - Country:US
Practice Address - Phone:419-278-1851
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-10171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist