Healthcare Provider Details

I. General information

NPI: 1508586710
Provider Name (Legal Business Name): KEILEIGH BRIAR FORRESTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 1ST STREET
KENNETT MO
63857-2522
US

IV. Provider business mailing address

1300 1ST STREET
KENNETT MO
63857-2522
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-8880
  • Fax:
Mailing address:
  • Phone: 573-888-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46617
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2022029736
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: