Healthcare Provider Details

I. General information

NPI: 1568383628
Provider Name (Legal Business Name): KALEB RYAN VESTAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

580 WALNUT ST APT 1104
CINCINNATI OH
45202-3161
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-8040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03447002
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: