Provider Demographics
NPI:1700396058
Name:LINAMEN, KEIGHLENE MAE
Entity Type:Individual
Prefix:
First Name:KEIGHLENE
Middle Name:MAE
Last Name:LINAMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEIGHLENE
Other - Middle Name:MAE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 W HOME RD
Mailing Address - Street 2:
Mailing Address - City:EMLENTON
Mailing Address - State:PA
Mailing Address - Zip Code:16373-8422
Mailing Address - Country:US
Mailing Address - Phone:814-316-1352
Mailing Address - Fax:
Practice Address - Street 1:11415 HYDETOWN RD
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1333
Practice Address - Country:US
Practice Address - Phone:814-827-0415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-01
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist