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General NPI Number Information
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NPI Number | 1376146118
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Entity Type | Individual
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Provider Name | DR. MICHAEL GARRET KERYESKI
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Gender | Male
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 9525 KENWOOD RD STE 1
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City | BLUE ASH
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State | OH
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Zip | 45242-6177
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Country | US
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Telephone | 513-793-7171
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Fax |
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Provider Business Mailing Address
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Address Line | 161 JACOBS CT
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City | LOVELAND
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State | OH
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Zip | 45140-8547
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Country | US
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Telephone | 724-681-9815
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1003693
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License Number State | OH
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