Healthcare Provider Details

I. General information

NPI: 1114071800
Provider Name (Legal Business Name): KEAVENY DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MAIN AVE W
WINSTED MN
55395-7872
US

IV. Provider business mailing address

PO BOX 910
WINSTED MN
55395-0910
US

V. Phone/Fax

Practice location:
  • Phone: 320-485-2555
  • Fax: 320-485-4266
Mailing address:
  • Phone: 320-485-2555
  • Fax: 320-485-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number263701
License Number StateMN

VIII. Authorized Official

Name: DEBORAH KEAVENY
Title or Position: OWNER
Credential:
Phone: 612-791-6687