Provider Demographics
NPI:1346984051
Name:PREBBLE, KEATON LLOYD (PHARMACY INTERN)
Entity Type:Individual
Prefix:
First Name:KEATON
Middle Name:LLOYD
Last Name:PREBBLE
Suffix:
Gender:M
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 TATES CREEK CENTRE DR STE 156
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3096
Mailing Address - Country:US
Mailing Address - Phone:859-273-0222
Mailing Address - Fax:
Practice Address - Street 1:4101 TATES CREEK CENTRE DR STE 156
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3096
Practice Address - Country:US
Practice Address - Phone:859-273-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYI146883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy