Provider Demographics
NPI:1659952786
Name:KEENE, MARY K (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:KEENE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 POUNDING MILL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-3730
Mailing Address - Country:US
Mailing Address - Phone:276-210-5784
Mailing Address - Fax:
Practice Address - Street 1:1135 CLAYPOOL HILL MALL RD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-7013
Practice Address - Country:US
Practice Address - Phone:276-964-5748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43990183500000X
VA0202216510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist