Healthcare Provider Details

I. General information

NPI: 1699921304
Provider Name (Legal Business Name): KEITH OLIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 NEW HAMPSHIRE AVE WO51
SILVER SPRING MD
20903-1058
US

IV. Provider business mailing address

11062 HARDING RD
SCAGGSVILLE MD
20723-2034
US

V. Phone/Fax

Practice location:
  • Phone: 301-796-0962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14706
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: