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NPI Code Detail

MEDICARE: MR. KEITH A MCKINNISS RPH

MEDICARE: MR. KEITH A MCKINNISS RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03124661OH
2183500000XPharmacist03-1-24661OH

General Provider Information

NPI Number : 1780678060
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH A MCKINNISS RPH
Provider Business Mailing Address
First Line : 30381 CHIEFTAIN DR
Second Line :
City : LOGAN
State : OH
Zip : 43138-9092
Country : US
Telephone Number : 740-385-3120
Fax Number :
Provider Business Practice Location Address
First Line : 30381 CHIEFTAIN DR
Second Line :
City : LOGAN
State : OH
Zip : 43138-9092
Country : US
Telephone Number : 740-385-3120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 05/10/2021

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