Provider Demographics
NPI:1710574942
Name:KEERAN, ERIN (RPH)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KEERAN
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 1:1309 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2601
Mailing Address - Country:US
Mailing Address - Phone:503-295-7941
Mailing Address - Fax:503-295-7707
Practice Address - Street 1:1309 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2601
Practice Address - Country:US
Practice Address - Phone:503-295-7941
Practice Address - Fax:503-295-7707
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist