Healthcare Provider Details

I. General information

NPI: 1427913995
Provider Name (Legal Business Name): KEEGAN THOMAS ILENDA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E NICOLLET BLVD
BURNSVILLE MN
55337-5714
US

IV. Provider business mailing address

201 E NICOLLET BLVD
BURNSVILLE MN
55337-5714
US

V. Phone/Fax

Practice location:
  • Phone: 952-892-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number123753
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: