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NPI Code Detail

MEDICARE: MS. DEBORAH LYNN KEITH RPH, CGP

MEDICARE:  MS. DEBORAH LYNN KEITH  RPH, CGP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist042786MO

General Provider Information

NPI Number : 1033482302
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEBORAH LYNN KEITH RPH, CGP
Provider Business Mailing Address
First Line : 687 CORNETT BRANCH RD
Second Line :
City : LAKE OZARK
State : MO
Zip : 65049-4809
Country : US
Telephone Number : 573-280-8600
Fax Number :
Provider Business Practice Location Address
First Line : 919 HIGHWAY D
Second Line :
City : OSAGE BEACH
State : MO
Zip : 65065-3169
Country : US
Telephone Number : 573-348-5963
Fax Number : 573-348-5963
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2012
Last Update Date : 02/17/2012

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Directions to “ MS. DEBORAH LYNN KEITH RPH, CGP” Practice Location

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