Healthcare Provider Details

I. General information

NPI: 1558564120
Provider Name (Legal Business Name): ANDREW KEENAN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N PEACH AVE STE B12
CLOVIS CA
93611-7255
US

IV. Provider business mailing address

585 HERITAGE AVE
CLOVIS CA
93619-7640
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-0246
  • Fax: 559-226-1440
Mailing address:
  • Phone: 559-325-0246
  • Fax: 559-226-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: