Provider Demographics
NPI:1518248541
Name:KEETON, MINDY LEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:LEE
Last Name:KEETON
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 1:1520 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4809
Mailing Address - Country:US
Mailing Address - Phone:219-663-0336
Mailing Address - Fax:
Practice Address - Street 1:1520 S COURT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4809
Practice Address - Country:US
Practice Address - Phone:219-663-0336
Practice Address - Fax:219-663-8647
Is Sole Proprietor?:No
Enumeration Date:2011-09-03
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021666A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist