MEDICARE: HOLLY A KEESY 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	32432	TX

General Provider Information

NPI Number	:	1891089173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY A KEESY RPH

Provider Business Mailing Address
First Line	:	751 ALTA MERE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1526
Country	:	US
Telephone Number	:	817-566-0566
Fax Number	:	817-566-0576

Provider Business Practice Location Address
First Line	:	751 ALTA MERE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1526
Country	:	US
Telephone Number	:	817-566-0566
Fax Number	:	817-566-0576

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

Provider Enumeration Date	:	06/04/2011
Last Update Date	:	06/04/2011

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Directions to “ HOLLY A KEESY RPH” Practice Location

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