Provider Demographics
NPI:1417025214
Name:LOUIS M CALDWELL JR
Entity Type:Organization
Organization Name:LOUIS M CALDWELL JR
Other - Org Name:KEENE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-558-3341
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059-0566
Mailing Address - Country:US
Mailing Address - Phone:817-552-3341
Mailing Address - Fax:817-651-8452
Practice Address - Street 1:114 S OLD BETSY RD
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059-2425
Practice Address - Country:US
Practice Address - Phone:817-558-3341
Practice Address - Fax:817-641-8752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
TX201553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144937Medicaid
2098101OtherPK
2098101OtherPK