Provider Demographics
NPI:1982692679
Name:JOHN D KEEGAN
Entity Type:Organization
Organization Name:JOHN D KEEGAN
Other - Org Name:HEGIHTS TERRACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KEEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-454-8748
Mailing Address - Street 1:475 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-7732
Mailing Address - Country:US
Mailing Address - Phone:570-454-8748
Mailing Address - Fax:570-455-1113
Practice Address - Street 1:475 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-7732
Practice Address - Country:US
Practice Address - Phone:570-454-8748
Practice Address - Fax:570-455-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410030L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008817820001Medicaid
PA0008817820001Medicaid