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General NPI Number Information
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NPI Number | 1154976694
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Entity Type | Individual
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Provider Name | SIMON KEEGAN
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Gender | Male
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 1460 RITCHIE HWY
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City | ARNOLD
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State | MD
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Zip | 21012-2730
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Country | US
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Telephone | 443-949-8373
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Fax |
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Provider Business Mailing Address
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Address Line | 8198 POINSETT TER
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City | PASADENA
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State | MD
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Zip | 21122-3850
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Country | US
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Telephone | 315-868-8358
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26629
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License Number State | MD
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