Healthcare Provider Details

I. General information

NPI: 1174092746
Provider Name (Legal Business Name): KEAVENY DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/13/2018
Certification Date:
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: 230-485-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH KEAVENY
Title or Position: PRESIDENT
Credential:
Phone: 320-485-2555