Provider Demographics
NPI:1356949713
Name:MCKIE, KEITH (RPH)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:MCKIE
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 1:64564 RESEARCH RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-8583
Mailing Address - Country:US
Mailing Address - Phone:775-843-8348
Mailing Address - Fax:
Practice Address - Street 1:64564 RESEARCH RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-8583
Practice Address - Country:US
Practice Address - Phone:775-843-8348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist