Most Relevant Information
Provider Data
| NPI Number: | 1003223793 |
| Provider Name: | KEITH PROUTY PHMD |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 059304 |
Most Important Dates
| Enumeration Date: | 07/15/2014 |
| Last Updated: | 07/15/2014 |
Provider Practice Location
142 E CENTER ST
MEDINA
NY
141031621
Practice Location Phone/Fax
| Phone: | 5857981212 |
| Fax: | 5857982041 |
Provider Mailing Location
142 E CENTER ST
MEDINA
NY
141031621
Provider Mailing Phone/Fax
| Phone: | 5857981212 |
| Fax: | 5857982041 |