Healthcare Provider Details

I. General information

NPI: 1053728766
Provider Name (Legal Business Name): KIRSTIN KECK PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 GAIL GARDNER WAY
PRESCOTT AZ
86305-1641
US

IV. Provider business mailing address

345 S VIRGINIA ST UNIT 9
PRESCOTT AZ
86303-4469
US

V. Phone/Fax

Practice location:
  • Phone: 928-541-0562
  • Fax: 928-541-0584
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS019865
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: