Healthcare Provider Details

I. General information

NPI: 1477252419
Provider Name (Legal Business Name): KEITH LEMUEL EARNEST PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43563 HWY 299E,
FALL RIVER MILLS CA
96028
US

IV. Provider business mailing address

PO BOX 459
FALL RIVER MILLS CA
96028
US

V. Phone/Fax

Practice location:
  • Phone: 530-335-5511
  • Fax: 530-440-7207
Mailing address:
  • Phone: 530-336-5511
  • Fax: 530-440-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH50157
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13507
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: