Provider Demographics
NPI:1497040935
Name:KEOWN, DENISE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:KEOWN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45155 FIRST COLONY WAY
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2416
Mailing Address - Country:US
Mailing Address - Phone:301-862-5342
Mailing Address - Fax:301-862-5342
Practice Address - Street 1:45155 FIRST COLONY WAY T-1258
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-2416
Practice Address - Country:US
Practice Address - Phone:301-862-5342
Practice Address - Fax:301-862-5342
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist