Provider Demographics
NPI:1538418637
Name:KEENEY, LAURI STUMP (RPH)
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:STUMP
Last Name:KEENEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671
Mailing Address - Country:US
Mailing Address - Phone:864-859-7168
Mailing Address - Fax:864-878-3196
Practice Address - Street 1:204 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671
Practice Address - Country:US
Practice Address - Phone:864-859-7168
Practice Address - Fax:864-878-3196
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist