Provider Demographics
NPI:1821301854
Name:KEENAN, TELEATHA LORRAINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TELEATHA
Middle Name:LORRAINE
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 E BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6870
Mailing Address - Country:US
Mailing Address - Phone:602-276-0778
Mailing Address - Fax:
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13601183500000X
WY2938183500000X
PARP444198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY2938OtherWYOMING STATE BOARD OF PHARMACY
AZ13601OtherARIZONA STATE BOARD OF PHARMACY
PARP444198OtherPENNSYLVANIA STATE BOARD OF PHARMACY