Provider Demographics
NPI:1083305155
Name:FITZGERALD, KEEGAN LEE (CPHT-TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:KEEGAN
Middle Name:LEE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:CPHT-TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-1313
Mailing Address - Country:US
Mailing Address - Phone:603-690-0670
Mailing Address - Fax:603-886-1442
Practice Address - Street 1:331 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4601
Practice Address - Country:US
Practice Address - Phone:603-886-9210
Practice Address - Fax:603-886-1442
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHCPHT-123863183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician