Provider Demographics
NPI:1386971828
Name:KEEVER, KENNETH WILSON (PHARM D, CGP)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WILSON
Last Name:KEEVER
Suffix:
Gender:M
Credentials:PHARM D, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 OAK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9651
Mailing Address - Country:US
Mailing Address - Phone:336-307-3507
Mailing Address - Fax:
Practice Address - Street 1:4204 OAK HOLLOW DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9651
Practice Address - Country:US
Practice Address - Phone:336-307-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65801835G0303X
VA02022067851835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric