Provider Demographics
NPI:1689034498
Name:KEAST-DEVINE, MEREDYTH (PHARMD BCPP)
Entity type:Individual
Prefix:DR
First Name:MEREDYTH
Middle Name:
Last Name:KEAST-DEVINE
Suffix:
Gender:F
Credentials:PHARMD BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1596
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93423
Mailing Address - Country:US
Mailing Address - Phone:805-674-2867
Mailing Address - Fax:
Practice Address - Street 1:4875 SHADOW CANYON RD BLDG B
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9714
Practice Address - Country:US
Practice Address - Phone:805-674-2867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH429591835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 42959OtherCALIFORNIA PHARMACIST LICENSE