Individual
MR. KEITH PERSICKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHAM.D.
Contact information
Practice address
15510 E SPRAGUE AVE, SPOKANE VALLEY, WA 99037-8945
(509) 891-0735
(509) 891-4082
Mailing address
21200 E COUNTRY VISTA DR, J101, LIBERTY LAKE, WA 99019-7636
(406) 240-1313
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
MT4525
MT
183500000X
Pharmacist
Primary
PH00049819
WA
Other
Enumeration date
01/21/2010
Last updated
01/21/2010
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