Healthcare Provider Details

I. General information

NPI: 1306778642
Provider Name (Legal Business Name): KEAVENY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BROADWAY AVE S
COKATO MN
55321-4681
US

IV. Provider business mailing address

PO BOX 340
COKATO MN
55321-0340
US

V. Phone/Fax

Practice location:
  • Phone: 320-286-2380
  • Fax: 320-286-2619
Mailing address:
  • Phone: 320-286-2380
  • Fax: 320-286-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KELLY JAMES KEAVENY
Title or Position: OWNER
Credential: RPH
Phone: 320-286-2380