Provider Demographics
NPI:1477078129
Name:KEITH, EMILY ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:KEITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-8803
Mailing Address - Country:US
Mailing Address - Phone:910-298-9172
Mailing Address - Fax:910-298-9950
Practice Address - Street 1:115 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518
Practice Address - Country:US
Practice Address - Phone:102-989-1729
Practice Address - Fax:910-298-9950
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27280183500000X
NC72780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist