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NPI Code Detail

MEDICARE: MR. KEITH HARRISON WRIGHT RPH

MEDICARE: MR. KEITH HARRISON WRIGHT 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
1183500000XPharmacist005754SC

General Provider Information

NPI Number : 1235200395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH HARRISON WRIGHT RPH
Provider Business Mailing Address
First Line : 507 10TH AVE S
Second Line :
City : NORTH MYRTLE BEACH
State : SC
Zip : 29582-3527
Country : US
Telephone Number : 843-272-4401
Fax Number : 843-272-0951
Provider Business Practice Location Address
First Line : 720 MAIN ST
Second Line :
City : NORTH MYRTLE BEACH
State : SC
Zip : 29582-3030
Country : US
Telephone Number : 843-249-4794
Fax Number : 843-249-4794
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2006
Last Update Date : 07/08/2007

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