Provider Demographics
NPI:1689659856
Name:KEITH, GREGORY STUART (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STUART
Last Name:KEITH
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:PO BOX 1623
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-1623
Mailing Address - Country:US
Mailing Address - Phone:209-334-4908
Mailing Address - Fax:
Practice Address - Street 1:2449 W KETTLEMAN LANE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242
Practice Address - Country:US
Practice Address - Phone:209-367-7882
Practice Address - Fax:209-367-7886
Is Sole Proprietor?:No
Enumeration Date:2005-12-10
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH39476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist