Provider Demographics
NPI:1144689605
Name:MILLER, KEEGAN (PHARMD)
Entity type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:MILLER
Suffix:
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 1:207 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-2199
Mailing Address - Country:US
Mailing Address - Phone:570-765-8106
Mailing Address - Fax:
Practice Address - Street 1:210 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:ELYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17824-9770
Practice Address - Country:US
Practice Address - Phone:844-878-5562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI010008183500000X
PARP449937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist