Healthcare Provider Details

I. General information

NPI: 1902569437
Provider Name (Legal Business Name): LORI KECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 MOUNTAIN VIEW DR
WEST MIFFLIN PA
15122-2469
US

IV. Provider business mailing address

9901 MOUNTAIN VIEW DR
WEST MIFFLIN PA
15122-2469
US

V. Phone/Fax

Practice location:
  • Phone: 412-655-7333
  • Fax:
Mailing address:
  • Phone: 412-655-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP040942L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: