Provider Demographics
NPI:1427351311
Name:KEFFELER PHARMACEUTICAL INC
Entity type:Organization
Organization Name:KEFFELER PHARMACEUTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEFFELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-468-1866
Mailing Address - Street 1:260 HOSPITAL DR
Mailing Address - Street 2:STE 111
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4568
Mailing Address - Country:US
Mailing Address - Phone:707-468-1866
Mailing Address - Fax:707-468-1869
Practice Address - Street 1:260 HOSPITAL DR
Practice Address - Street 2:STE 111
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4568
Practice Address - Country:US
Practice Address - Phone:707-468-1866
Practice Address - Fax:707-468-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY505053336C0003X
3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129527OtherPK
5640443OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA6644030001Medicare NSC