Healthcare Provider Details

I. General information

NPI: 1598740433
Provider Name (Legal Business Name): KEVIN H NEIDIG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 1/2 W HIGH AVE
NEW PHILADELPHIA OH
44663-3802
US

IV. Provider business mailing address

3389 TABOR RIDGE RD NE
MINERAL CITY OH
44656-9313
US

V. Phone/Fax

Practice location:
  • Phone: 330-365-1526
  • Fax: 330-365-1513
Mailing address:
  • Phone: 330-602-9473
  • Fax: 330-343-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-14789
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: