Provider Demographics
NPI:1922619972
Name:KEEGAN, MARTIN RYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:RYAN
Last Name:KEEGAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 E ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2462
Mailing Address - Country:US
Mailing Address - Phone:913-787-1138
Mailing Address - Fax:
Practice Address - Street 1:11021 SHAWNEE MISSION PKWY
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-3515
Practice Address - Country:US
Practice Address - Phone:913-268-4980
Practice Address - Fax:913-268-4685
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-102838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist