Provider Demographics
NPI:1659146454
Name:CRIPPS, KEELIN ELIZABETH
Entity Type:Individual
Prefix:
First Name:KEELIN
Middle Name:ELIZABETH
Last Name:CRIPPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 MICOL RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-3114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46 ALLENSTOWN RD
Practice Address - Street 2:
Practice Address - City:ALLENSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03275-1809
Practice Address - Country:US
Practice Address - Phone:603-485-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHT128053183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician