Provider Demographics
NPI:1639468333
Name:CARSON, KEITH M (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:M
Last Name:CARSON
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 1:211 SWINNICK DR
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2072
Mailing Address - Country:US
Mailing Address - Phone:570-941-9440
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-1866
Practice Address - Country:US
Practice Address - Phone:570-342-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP439688OtherSTATE LISCENSE