Ezekiel Keereng Kesitilwe, PHARMD

Primary specialty

PharmacyTaxonomy code 333600000X

License

S013695 Issued in AZ

Practice address

1980 McCulloch Blvd N
Lake Havasu City, AZ 86403-0969

Phone

(928) 854-8281

Fax

(928) 453-3969

NPI assigned

Jan 18, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bridge Medical Services LLC

  • Community/Retail Pharmacy
  • Lake Havasu City, AZ
  • NPI 1851857270
  NPD Authorized official
• Ezyfast Pharmacy L L C

  • Community/Retail Pharmacy
  • Bullhead City, AZ
  • NPI 1366717860
  NPD Authorized official
• Ezyfast Pharmacy L L C

  • Community/Retail Pharmacy
  • Laughlin, NV
  • NPI 1063825222
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516233600000",
    "number": "1871001248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2734 PASEO VERDE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864067748",
            "telephone_number": "928-230-9812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1980 MCCULLOCH BLVD N",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864030969",
            "telephone_number": "928-854-8281",
            "fax_number": "928-453-3969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESITILWE",
        "first_name": "EZEKIEL",
        "middle_name": "KEERENG",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-18",
        "last_updated": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AZ",
            "license": "S013695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashutosh Kaushesh, D.D.S.
• Tod Dempsey Keam, O.T.R.
• Jennifer Keele, LMT
• Stephanie Lynn Kent, OCCUPATIONAL THERAPI
• Kevin Eugene Keough
• Kevin J Obrien DPM Inc
• Ronald Bernard Killian, DPM
• Chang Kim, D.M.D.
• Cheryl M Kingsbury, MS, OTR/L
• Deborah Ann Kinzer, D.D.S.

• Pharmacy in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.