Provider Demographics
NPI:1598811895
Name:KEEGAN, JOHN DAVID JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:KEEGAN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-7732
Mailing Address - Country:US
Mailing Address - Phone:570-454-8748
Mailing Address - Fax:570-455-1113
Practice Address - Street 1:475 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-7732
Practice Address - Country:US
Practice Address - Phone:570-454-8748
Practice Address - Fax:570-455-1113
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030100L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008817820001Medicaid
PA3944851OtherNCPDP
PA0008817820001Medicaid