Provider Demographics
NPI:1184969867
Name:KEITH, THOMAS ALLEN JR (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALLEN
Last Name:KEITH
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1905 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-2308
Mailing Address - Country:US
Mailing Address - Phone:864-253-1833
Mailing Address - Fax:864-253-1828
Practice Address - Street 1:1908 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2308
Practice Address - Country:US
Practice Address - Phone:864-253-1830
Practice Address - Fax:864-253-1828
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC4896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist