Provider Demographics
NPI:1982704037
Name:MCKEITHAN, OLIVER ALDERMAN IV (RPH)
Entity Type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:ALDERMAN
Last Name:MCKEITHAN
Suffix:IV
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:RR1 BOX 54A
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:PA
Mailing Address - Zip Code:18831-9720
Mailing Address - Country:US
Mailing Address - Phone:570-596-4008
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:SUITE L05 HENDERSONS DRUG II
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901
Practice Address - Country:US
Practice Address - Phone:607-271-9794
Practice Address - Fax:607-271-9315
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist