Provider Demographics
NPI:1770736548
Name:KEENAN, NICOLE (RPH)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KEENAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E BOULDER ST
Mailing Address - Street 2:#1160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5533
Mailing Address - Country:US
Mailing Address - Phone:719-365-8896
Mailing Address - Fax:719-365-6698
Practice Address - Street 1:UCHEALTH SPRINGS PHARMACY
Practice Address - Street 2:1400 E BOULDER ST
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-365-8896
Practice Address - Fax:719-365-6698
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist