Healthcare Provider Details

I. General information

NPI: 1841286903
Provider Name (Legal Business Name): KEITHS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 REDWOOD DR
GARBERVILLE CA
95542-3106
US

IV. Provider business mailing address

875 REDWOOD DR
GARBERVILLE CA
95542-3106
US

V. Phone/Fax

Practice location:
  • Phone: 707-923-2461
  • Fax: 707-923-4038
Mailing address:
  • Phone: 707-923-2461
  • Fax: 707-923-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number52423
License Number StateCA

VIII. Authorized Official

Name: KEITH LORANG
Title or Position: PIC/OWNER
Credential:
Phone: 707-923-2461