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General NPI Number Information
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NPI Number | 1134722671
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Entity Type | Individual
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Provider Name | DERRICK J KEENER CPHT
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Gender | Male
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 2640 E CUMBERLAND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3709
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Country | US
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Telephone | 215-291-8315
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Fax |
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Provider Business Mailing Address
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Address Line | 2640 E CUMBERLAND ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3709
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number |
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License Number State |
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