Provider Demographics
NPI:1811013667
Name:KEITES, LORRAINE N (RPH)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:N
Last Name:KEITES
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 886
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-0886
Mailing Address - Country:US
Mailing Address - Phone:352-481-4521
Mailing Address - Fax:352-481-3801
Practice Address - Street 1:126 POINT LOUISA RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640-5541
Practice Address - Country:US
Practice Address - Phone:352-481-4521
Practice Address - Fax:352-481-3801
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS14220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS14220OtherPHARMACIST
FLPU985OtherCONSULTANT PHARMACIST