Healthcare Provider Details

I. General information

NPI: 1902566771
Provider Name (Legal Business Name): KEITH MICHAEL WIRE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HOSPITAL DR STE 130
ATHENS OH
45701-2858
US

IV. Provider business mailing address

75 HOSPITAL DR STE 130
ATHENS OH
45701-2858
US

V. Phone/Fax

Practice location:
  • Phone: 740-992-4108
  • Fax: 740-992-5244
Mailing address:
  • Phone: 740-992-4108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03217369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: