Provider Demographics
NPI:1821744459
Name:LUKEHART, KEITH AARON (CPHT)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:AARON
Last Name:LUKEHART
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 N HIGHWAY 65
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-2702
Mailing Address - Country:US
Mailing Address - Phone:559-562-4404
Mailing Address - Fax:559-562-1685
Practice Address - Street 1:262 N HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-2702
Practice Address - Country:US
Practice Address - Phone:559-562-4404
Practice Address - Fax:559-562-1685
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139612183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician