Provider Demographics
NPI:1922362771
Name:KEETH, KRIS IRENE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRIS
Middle Name:IRENE
Last Name:KEETH
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 1:11912 NE FOURTH PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-5642
Mailing Address - Country:US
Mailing Address - Phone:360-944-8368
Mailing Address - Fax:360-944-6555
Practice Address - Street 1:11912 NE FOURTH PLAIN RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-5642
Practice Address - Country:US
Practice Address - Phone:360-944-8368
Practice Address - Fax:360-944-6555
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00039036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist