Provider Demographics
NPI:1871758169
Name:KEENE, ALISSA CAROLINE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:CAROLINE
Last Name:KEENE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:ALISSA
Other - Middle Name:CAROLINE
Other - Last Name:THEIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:401 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1701
Mailing Address - Country:US
Mailing Address - Phone:320-420-8737
Mailing Address - Fax:
Practice Address - Street 1:4801 VETERANS DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2015
Practice Address - Country:US
Practice Address - Phone:320-255-6345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist