Active NPI
Keeanne Preval
- Pharmacist
- Southbridge, MA
National Provider Identifier
1205644192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH1001116
- Practice address
- 399 Main St
Southbridge, MA 01550-3728 - Phone
- (508) 765-0646
- Fax
- (508) 764-7210
- NPI assigned
- Dec 23, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH1001116 | MA | Primary |
Addresses
Primary practice location
399 Main St
Southbridge, MA 01550-3728
Mailing address
399 Main St
Southbridge, MA 01550-3728
Phone (508) 765-7210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH1001116 | MA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734912000000",
"number": "1205644192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "399 MAIN ST",
"city": "SOUTHBRIDGE",
"state": "MA",
"postal_code": "015503728",
"telephone_number": "508-765-7210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "399 MAIN ST",
"city": "SOUTHBRIDGE",
"state": "MA",
"postal_code": "015503728",
"telephone_number": "508-765-0646",
"fax_number": "508-764-7210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREVAL",
"first_name": "KEEANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-23",
"last_updated": "2024-12-23",
"certification_date": "2024-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH1001116",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southbridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.