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General NPI Number Information
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NPI Number | 1306433230
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Entity Type | Individual
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Provider Name | SAMUEL KEEVEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2020
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Last Update Date | 12/27/2020
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Provider Practice Location Address
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Address Line | 101 E KARSCH BLVD
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City | FARMINGTON
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State | MO
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Zip | 63640-1235
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Country | US
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Telephone | 573-701-0639
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Fax |
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Provider Business Mailing Address
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Address Line | 7201A BEACH LN
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City | SAINTE GENEVIEVE
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State | MO
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Zip | 63670-8123
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Country | US
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Telephone | 314-477-3477
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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 | 2018044661
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License Number State | MO
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