Provider Demographics
NPI:1932470408
Name:AGUILLON-KEEP, ELIZA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:
Last Name:AGUILLON-KEEP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ELIZA
Other - Middle Name:
Other - Last Name:AGUILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1510 COOPER POINT RD SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5734
Mailing Address - Country:US
Mailing Address - Phone:360-570-8008
Mailing Address - Fax:
Practice Address - Street 1:1510 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5734
Practice Address - Country:US
Practice Address - Phone:360-570-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60096621183500000X
CARPH 59934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist