Patcharaporn Keane, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

051.296468 Issued in IL

Practice address

1004 Shooting Park Rd
Peru, IL 61354-1871

Phone

(815) 224-1411

NPI assigned

Dec 11, 2020

Sex

Female

Sole proprietor

No

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.

• Highland Park CVS LLC

  • Pharmacy
  • Peru, IL
  • NPI 1275574147
  NPD (past)

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1972199115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4902 N MAGNOLIA AVE APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407546",
            "telephone_number": "630-888-2551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 SHOOTING PARK RD",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613541871",
            "telephone_number": "815-224-1411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Winthrop Ave",
            "address_purpose": "LOCATION",
            "city": "Glendale Heights",
            "state": "IL",
            "postal_code": "601391405",
            "country_code": "US",
            "telephone_number": "630-545-7331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEANE",
        "first_name": "PATCHARAPORN",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.296468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karissa Lee Johnson, RPH
• Lisa Kelly Jones
• Joseph Kunnel DDS, PHD, PC
• Jill Kamphaus
• Connor Kasik
• Tara Ketner, RDN, LDN
• Alison Jeanne Kibilka, CRNA
• Won Yang Kim, M.D.
• Robert S Kinsella, D.O.
• Kamal Kishore, M.D.

• All providers in Peru, IL
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; 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.