Provider Demographics
NPI:1013497155
Name:KEEN, ALLYSON NOELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:NOELLE
Last Name:KEEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 W ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:AZ
Mailing Address - Zip Code:86046-2334
Mailing Address - Country:US
Mailing Address - Phone:928-635-5977
Mailing Address - Fax:
Practice Address - Street 1:637 W ROUTE 66
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:AZ
Practice Address - Zip Code:86046-2334
Practice Address - Country:US
Practice Address - Phone:928-635-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS023335OtherPHARMACIST LICENSE NUMBER