Provider Demographics
NPI:1235200395
Name:WRIGHT, KEITH HARRISON (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:HARRISON
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3527
Mailing Address - Country:US
Mailing Address - Phone:843-272-4401
Mailing Address - Fax:843-272-0951
Practice Address - Street 1:720 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3030
Practice Address - Country:US
Practice Address - Phone:843-249-4794
Practice Address - Fax:843-249-4794
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC005754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist