Healthcare Provider Details

I. General information

NPI: 1457480857
Provider Name (Legal Business Name): MARK KEETON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E 23RD AVE
HUTCHINSON KS
67502-1105
US

IV. Provider business mailing address

21 DAKOTA DR
HUTCHINSON KS
67502-4469
US

V. Phone/Fax

Practice location:
  • Phone: 620-665-2101
  • Fax: 620-665-2585
Mailing address:
  • Phone: 620-662-5790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-13190
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: