Provider Demographics
NPI:1982959151
Name:IAMS, KEITH LINDSAY (RPH)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:LINDSAY
Last Name:IAMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 PRINCE WILLIAM PKWY
Mailing Address - Street 2:T-0759
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4148
Mailing Address - Country:US
Mailing Address - Phone:703-490-4415
Mailing Address - Fax:
Practice Address - Street 1:2460 PRINCE WILLIAM PKWY
Practice Address - Street 2:T-0759
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4148
Practice Address - Country:US
Practice Address - Phone:703-490-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist