Provider Demographics
NPI:1083014518
Name:KEITH'S PARMACY LLC
Entity Type:Organization
Organization Name:KEITH'S PARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LORANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-923-2461
Mailing Address - Street 1:875 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GARBERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95542-3106
Mailing Address - Country:US
Mailing Address - Phone:707-923-2461
Mailing Address - Fax:707-923-4038
Practice Address - Street 1:875 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:GARBERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95542-3106
Practice Address - Country:US
Practice Address - Phone:707-923-2461
Practice Address - Fax:707-923-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty