Provider Demographics
NPI:1831580273
Name:KEITH, JEFFERY DEAN JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DEAN
Last Name:KEITH
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PASEO TERRAZA UNIT 205
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8877
Mailing Address - Country:US
Mailing Address - Phone:386-315-0349
Mailing Address - Fax:
Practice Address - Street 1:200 PASEO TERRAZA UNIT 205
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8877
Practice Address - Country:US
Practice Address - Phone:386-315-0349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist