Healthcare Provider Details

I. General information

NPI: 1790725000
Provider Name (Legal Business Name): WILLIAM A KECK III R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 EMERALD DR
CORBIN KY
40701-7426
US

IV. Provider business mailing address

42 EMERALD DR
CORBIN KY
40701-7426
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-8505
  • Fax:
Mailing address:
  • Phone: 606-528-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number008026
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: