Provider Demographics
NPI:1871887166
Name:DRENNEN, KEITH (RPH)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:DRENNEN
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 1:8151 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4111
Mailing Address - Country:US
Mailing Address - Phone:727-576-3826
Mailing Address - Fax:727-576-3826
Practice Address - Street 1:8151 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4111
Practice Address - Country:US
Practice Address - Phone:727-576-3826
Practice Address - Fax:727-576-3826
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 37580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist