Healthcare Provider Details

I. General information

NPI: 1730777830
Provider Name (Legal Business Name): NESLIHAN KEEFER R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NESLI KEEFER

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W MAIN ST
MAPLE SHADE NJ
08052-2411
US

IV. Provider business mailing address

21 HICKORY RIDGE CT
MULLICA HILL NJ
08062-4636
US

V. Phone/Fax

Practice location:
  • Phone: 856-779-8300
  • Fax: 856-779-9022
Mailing address:
  • Phone: 856-912-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number28RI02656500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02656500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: