Provider Demographics
NPI:1417247867
Name:KEATON, ANNA M (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:KEATON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15945 CLAYTON ROAD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2146
Mailing Address - Country:US
Mailing Address - Phone:636-256-5111
Mailing Address - Fax:636-256-5196
Practice Address - Street 1:15945 CLAYTON ROAD
Practice Address - Street 2:SUITE 140
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2146
Practice Address - Country:US
Practice Address - Phone:636-256-5111
Practice Address - Fax:636-256-5196
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000154899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist