DR. KEITH ROBERT FAIRALL (NPI# 1104372572) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104372572 |
| Entity Type | Individual |
| Full Name | DR. KEITH ROBERT FAIRALL |
| Credential | PHARMD |
| Practice Address |
525 Fox Gap Rd Bangor PA 18013-5832 |
| Practice Telephone | 6109847564 |
| Mailing Telephone | 6109847564 |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2016-08-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | RP447716 | PA | Pharmacy Service Providers |
| Street Address |
525 FOX GAP RD |
| City | BANGOR |
| State | PA |
| Zip Code | 18013-5832 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104298140 | Blue Valley Vision LLC | Eyewear Supplier (Equipment, not the service) | 455 Blue Valley Dr, Bangor, PA 18013 | 2015-10-29 |
| 1588064554 | Roxanne Decesare | Reflexologist | 429 South First St, Bangor, PA 18013 | 2014-08-27 |
| 1467781708 | Shadys Rest | Preferred Provider Organization | 1004 W Juniata Street, Allentown, PA 18013 | 2009-12-16 |
| 1912911371 | Richard J Weaver | Chiropractor | 83 Bangor Junction Road, Blue Valley Plaza, Bangor, PA 18013 | 2006-07-28 |
| 1104373265 | Heavenly Vision | Technician/Technologist | 455 Blue Valley Dr, Bangor, PA 18013 | 2016-09-07 |
| 1881059293 | Timothy James Velekei Sr. | Technician/Technologist | 455 Blue Valley Dr, Bangor, PA 18013 | 2015-12-30 |
| 1629492608 | Elizabeth Kostura | Counselor | 51 Market Street, Bangor, PA 18013 | 2014-02-11 |
| 1518261593 | Carol Augusta Olzinski | Social Worker | 51 Market Street, Bangor, PA 18013 | 2011-01-05 |
| 1073846390 | Christa Robinson | Specialist/Technologist | 19 Columbus St, Apt 3, Roseto, PA 18013 | 2009-09-18 |
| 1326096587 | Matthew Nicholas Sabatine Jr. | Dentist | 137 Broadway, Bangor, PA 18013 | 2006-05-04 |
| Find all providers in zip 18013 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336709377 | Jordan Christine Anderson | Pharmacist | 183 Center St, Bangor, ME 04401-4839 | 2019-06-20 |
| 1275056509 | Corey Michael Taylor | Pharmacist | 66 Court St Apt C, Bangor, ME 04401-4765 | 2017-07-19 |
| 1851761803 | Reagan Scott | Pharmacist | 111 Allen St Apt 4, Bangor, ME 04401-4477 | 2015-10-03 |
| 1144535352 | Lawrence A Sandi | Pharmacist | 682 Ohio St Apt 45, Bangor, ME 04401-3198 | 2010-08-11 |
| 1356675391 | Daniela Desantis | Pharmacist | 566 Union St, Bangor, ME 04401-3752 | 2009-09-23 |
| 1306076583 | Harini Pappu | Pharmacist | 226 Union St, Bangor, ME 04401-6160 | 2009-07-21 |
| 1629215470 | Shelly A Turner | Pharmacist | 438 Birch St, Bangor, ME 04401-4028 | 2009-01-15 |
| 1104092824 | Joyce Anna Beery | Pharmacist | 450 Blue Valley Dr, Bangor, PA 18013-1525 | 2008-05-02 |
| 1265537534 | Robin Brittelli | Pharmacist | 1012 Union St., Ste 5, Bangor, ME 04401-0000 | 2006-09-13 |
| 1770593147 | Terryl Ensign | Pharmacist | 211 W Monroe St, Bangor, MI 49013-1330 | 2006-08-09 |
| Find all providers in BANGOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.