MEDICARE: STEVE KEEN RPH

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	36357	SC

General Provider Information

NPI Number	:	1730539057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVE KEEN RPH

Provider Business Mailing Address
First Line	:	3915 N KINGS HWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-2742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3915 N KINGS HWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-2742
Country	:	US
Telephone Number	:	843-839-9875
Fax Number	:

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

Provider Enumeration Date	:	06/17/2016
Last Update Date	:	06/17/2016

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