Provider Demographics
NPI:1871633230
Name:HATFIELD, KEITH DEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DEE
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W HOPI DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025-2852
Mailing Address - Country:US
Mailing Address - Phone:928-524-2661
Mailing Address - Fax:928-524-3123
Practice Address - Street 1:702 W HOPI DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-2852
Practice Address - Country:US
Practice Address - Phone:928-524-2661
Practice Address - Fax:928-524-3123
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist