Provider Demographics
NPI:1902569437
Name:KECK, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KECK
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 1:9901 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-2469
Mailing Address - Country:US
Mailing Address - Phone:412-655-7333
Mailing Address - Fax:
Practice Address - Street 1:9901 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2469
Practice Address - Country:US
Practice Address - Phone:412-655-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040942L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist