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NPI Code Detail

MEDICARE: KEITH DAUGHERTY RPH

MEDICARE: KEITH DAUGHERTY 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
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist7178OR
2183500000XPharmacist7178OR

General Provider Information

NPI Number : 1518268234
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH DAUGHERTY RPH
Provider Business Mailing Address
First Line : 60951 SE SWEET PEA DR
Second Line :
City : BEND
State : OR
Zip : 97702-9759
Country : US
Telephone Number : 541-912-1245
Fax Number :
Provider Business Practice Location Address
First Line : 20120 PINEBROOK BLVD
Second Line :
City : BEND
State : OR
Zip : 97702-2537
Country : US
Telephone Number : 541-389-5440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2010
Last Update Date : 04/11/2018

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Directions to “ KEITH DAUGHERTY RPH” Practice Location

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