Provider Demographics
NPI:1548307572
Name:KEENER, DAVID BRUCE (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRUCE
Last Name:KEENER
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 1:823 W OAKRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2753
Mailing Address - Country:US
Mailing Address - Phone:248-545-3641
Mailing Address - Fax:
Practice Address - Street 1:600 E LAFAYETTE BLVD
Practice Address - Street 2:MC J103
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-2927
Practice Address - Country:US
Practice Address - Phone:313-225-6356
Practice Address - Fax:313-225-4846
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist