Provider Demographics
NPI:1831572585
Name:KEYLIN, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KEYLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DALTON WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-5305
Mailing Address - Country:US
Mailing Address - Phone:267-364-5392
Mailing Address - Fax:
Practice Address - Street 1:1137 BUSTLETON PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7609
Practice Address - Country:US
Practice Address - Phone:215-354-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046843OtherNY LICENSE
NJ27525OtherNJ LICENSE
PARP441333OtherPA LICENSE