Provider Demographics
NPI:1669483780
Name:KEHOE, WILLIAM A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:KEHOE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9987 RIVER VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4162
Mailing Address - Country:US
Mailing Address - Phone:209-946-2534
Mailing Address - Fax:209-946-2410
Practice Address - Street 1:1617 N CALIFORNIA ST
Practice Address - Street 2:GREEN BROS. PHARMACY SUITE 1F
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:209-948-6435
Practice Address - Fax:209-235-0241
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist