Healthcare Provider Details

I. General information

NPI: 1134722671
Provider Name (Legal Business Name): DERRICK J KEENER CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25109 RYAN RD
WARREN MI
48091-1324
US

IV. Provider business mailing address

25109 RYAN RD
WARREN MI
48091-1324
US

V. Phone/Fax

Practice location:
  • Phone: 586-756-8900
  • Fax: 586-754-1875
Mailing address:
  • Phone: 586-756-8900
  • Fax: 586-754-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: