Provider Demographics
NPI:1720571813
Name:VENJOHN, KEITH EARNEST (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:EARNEST
Last Name:VENJOHN
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 1:430 SUSAN ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-8336
Mailing Address - Country:US
Mailing Address - Phone:620-272-3049
Mailing Address - Fax:
Practice Address - Street 1:3101 EAST KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846
Practice Address - Country:US
Practice Address - Phone:620-275-7557
Practice Address - Fax:620-275-5078
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist