Active NPI
Jimmy Dale Keith Jr., RPH
- Pharmacist
- Kernersville, NC
National Provider Identifier
1679807481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10715
- Practice address
- 207 Oakway Ridge CT
Kernersville, NC 27284-7455 - Phone
- (336) 992-6814
- NPI assigned
- Sep 25, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 | 10715 | NC | Primary |
Addresses
Primary practice location
207 Oakway Ridge CT
Kernersville, NC 27284-7455
Mailing address
1427A NC Highway 68 N
Oak Ridge, NC 27310-9768
Phone (336) 703-7580
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10715 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689638400000",
"number": "1679807481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1427A NC HIGHWAY 68 N",
"city": "OAK RIDGE",
"state": "NC",
"postal_code": "273109768",
"telephone_number": "336-703-7580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 OAKWAY RIDGE CT",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272847455",
"telephone_number": "336-992-6814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEITH",
"first_name": "JIMMY",
"middle_name": "DALE",
"name_suffix": "Jr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-25",
"last_updated": "2023-07-18",
"certification_date": "2023-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "10715",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.