Provider Demographics
NPI:1558019224
Name:KEENE, SOPHIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:KEENE
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 1:85 FULTON ST UNIT 9A
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1912
Mailing Address - Country:US
Mailing Address - Phone:973-299-2500
Mailing Address - Fax:
Practice Address - Street 1:85 FULTON ST UNIT 9A
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1912
Practice Address - Country:US
Practice Address - Phone:973-299-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03798900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist