Provider Demographics
NPI:1679821698
Name:KEENER, MARTINA LOOSER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:LOOSER
Last Name:KEENER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 S PLEASANTBURG DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1329
Mailing Address - Country:US
Mailing Address - Phone:864-299-3141
Mailing Address - Fax:864-277-3524
Practice Address - Street 1:1292 S PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1329
Practice Address - Country:US
Practice Address - Phone:864-299-3141
Practice Address - Fax:864-277-3524
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist