Healthcare Provider Details

I. General information

NPI: 1992396501
Provider Name (Legal Business Name): TIM KEFFELER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR STE 111
UKIAH CA
95482-4568
US

IV. Provider business mailing address

260 HOSPITAL DR STE 111
UKIAH CA
95482-4568
US

V. Phone/Fax

Practice location:
  • Phone: 707-468-1866
  • Fax: 707-468-1869
Mailing address:
  • Phone: 707-468-1866
  • Fax: 707-468-1869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: