Provider Demographics
NPI:1063166783
Name:KEATON, BRANDI ALEXANDRA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:ALEXANDRA
Last Name:KEATON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 ROBERT C. BYRD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827
Mailing Address - Country:US
Mailing Address - Phone:304-253-7474
Mailing Address - Fax:304-253-7495
Practice Address - Street 1:221 GEORGE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2609
Practice Address - Country:US
Practice Address - Phone:681-207-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0012663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist