Provider Demographics
NPI:1598361818
Name:CHOQUETTE, KEITH GARY (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:GARY
Last Name:CHOQUETTE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 MARIANO BISHOP BLVD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-2349
Mailing Address - Country:US
Mailing Address - Phone:508-675-0887
Mailing Address - Fax:508-675-0164
Practice Address - Street 1:333 MARIANO BISHOP BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-2349
Practice Address - Country:US
Practice Address - Phone:508-675-0887
Practice Address - Fax:508-675-0164
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA23759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1134154164Medicaid