Provider Demographics
NPI:1073646139
Name:METCALF, KEITH (PHARMD, BCNSP)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:METCALF
Suffix:
Gender:M
Credentials:PHARMD, BCNSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6613 ETON CT
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2774
Mailing Address - Country:US
Mailing Address - Phone:817-737-7778
Mailing Address - Fax:817-737-9333
Practice Address - Street 1:1400 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4110
Practice Address - Country:US
Practice Address - Phone:817-927-6141
Practice Address - Fax:817-922-1799
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210431835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support