Provider Demographics
NPI:1346538287
Name:ANDRUS, KEATON STEELE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEATON
Middle Name:STEELE
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 IAN DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2762
Mailing Address - Country:US
Mailing Address - Phone:317-874-8190
Mailing Address - Fax:
Practice Address - Street 1:807 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-6500
Practice Address - Country:US
Practice Address - Phone:423-439-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN45016903A390200000X
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program