Provider Demographics
NPI:1053984773
Name:KEELER, MARCIA G
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:G
Last Name:KEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 W WESTERN RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3592
Mailing Address - Country:US
Mailing Address - Phone:330-629-7345
Mailing Address - Fax:330-629-7353
Practice Address - Street 1:1135 W WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3592
Practice Address - Country:US
Practice Address - Phone:330-629-7345
Practice Address - Fax:330-629-7353
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist