Provider Demographics
NPI:1609198514
Name:HARSE, KEEGAN NEIL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEEGAN
Middle Name:NEIL
Last Name:HARSE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 SARANAC AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-1149
Mailing Address - Country:US
Mailing Address - Phone:518-523-5305
Mailing Address - Fax:
Practice Address - Street 1:250 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2913
Practice Address - Country:US
Practice Address - Phone:315-343-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053761183500000X
NY053761-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist