Provider Demographics
NPI:1225323850
Name:KEENAN, STACIE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 TANBARK PLAZA
Mailing Address - Street 2:
Mailing Address - City:LOVINGSTON
Mailing Address - State:VA
Mailing Address - Zip Code:22948
Mailing Address - Country:US
Mailing Address - Phone:434-263-4224
Mailing Address - Fax:434-263-5106
Practice Address - Street 1:74 TANBARK PLAZA
Practice Address - Street 2:
Practice Address - City:LOVINGSTON
Practice Address - State:VA
Practice Address - Zip Code:22948
Practice Address - Country:US
Practice Address - Phone:434-263-4224
Practice Address - Fax:434-263-5106
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist