Healthcare Provider Details

I. General information

NPI: 1225572894
Provider Name (Legal Business Name): RACHEL LYNN KECK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

IV. Provider business mailing address

528 CUMBERLAND DR
MUSKOGEE OK
74403-8315
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-3000
  • Fax:
Mailing address:
  • Phone: 918-869-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16227
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: