MEDICARE: MRS. SUSAN DIANE KEEFE PHARMACIST

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
1	183500000X	Pharmacist	RP028219L	PA

General Provider Information

NPI Number	:	1376770271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN DIANE KEEFE PHARMACIST

Provider Business Mailing Address
First Line	:	124 HARPHEN ST
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15132-6618
Country	:	US
Telephone Number	:	412-672-2826
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 LINCOLN WAY
Second Line	:
City	:	WHITE OAK
State	:	PA
Zip	:	15131-1713
Country	:	US
Telephone Number	:	412-672-5576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	06/18/2009

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