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General NPI Number Information
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NPI Number | 1861546509
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Entity Type | Organization
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Legal Business Name | KEAVENY PHARMACY INC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 205 BROADWAY AVE S
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City | COKATO
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State | MN
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Zip | 55321-4681
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Country | US
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Telephone | 320-286-5483
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Fax | 320-286-6365
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Provider Business Mailing Address
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Address Line | PO BOX 340
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City | COKATO
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State | MN
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Zip | 55321-0340
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Country | US
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Telephone | 320-286-5483
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Fax | 320-286-6365
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Authorized Official
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Title or Position | OWNER
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Name | DEBORAH KEAVENY
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Credential |
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Telephone | 612-791-6687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 263708
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License Number State | MN
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