Provider Demographics
NPI:1720314388
Name:KEEFER WILLIAMS, DAJEN RUNGE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAJEN
Middle Name:RUNGE
Last Name:KEEFER WILLIAMS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DAJEN
Other - Middle Name:RUNGE
Other - Last Name:KEEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9848 GILEAD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7511
Mailing Address - Country:US
Mailing Address - Phone:704-948-7237
Mailing Address - Fax:
Practice Address - Street 1:9848 GILEAD RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7511
Practice Address - Country:US
Practice Address - Phone:704-948-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist