Provider Demographics
NPI:1083370985
Name:DEPATIS, KERI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:
Last Name:DEPATIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 FERN ST APT 805
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5967
Mailing Address - Country:US
Mailing Address - Phone:815-953-9591
Mailing Address - Fax:
Practice Address - Street 1:11211 PROSPERITY FARMS RD STE C211
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3401
Practice Address - Country:US
Practice Address - Phone:561-743-4911
Practice Address - Fax:561-743-2998
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS581441835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care