Provider Demographics
NPI:1720556459
Name:KEAVENY, DEBORAH (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KEAVENY
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:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:MN
Mailing Address - Zip Code:55395-0910
Mailing Address - Country:US
Mailing Address - Phone:320-485-2555
Mailing Address - Fax:320-485-4266
Practice Address - Street 1:150 MAIN AVE W
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:MN
Practice Address - Zip Code:55395-7872
Practice Address - Country:US
Practice Address - Phone:320-485-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist