Provider Demographics
NPI:1326133174
Name:KEENER, KENNETH GERALD (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:GERALD
Last Name:KEENER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5625 WATER TOWER PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2671
Mailing Address - Country:US
Mailing Address - Phone:248-625-1215
Mailing Address - Fax:248-620-4258
Practice Address - Street 1:5625 WATER TOWER PL
Practice Address - Street 2:SUITE 101
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2671
Practice Address - Country:US
Practice Address - Phone:248-625-1215
Practice Address - Fax:248-620-4258
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist