DR. EZEKIEL KEERENG KESITILWE (NPI# 1871001248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871001248 |
| Entity Type | Individual |
| Full Name | DR. EZEKIEL KEERENG KESITILWE |
| Credential | PHARMD |
| Practice Address |
1980 Mcculloch Blvd N Lake Havasu City AZ 86403-0969 |
| Mailing Address |
2734 Paseo Verde Lake Havasu City AZ 86406-7748 |
| Practice Telephone | 9288548281 |
| Practice Fax Number | 9284533969 |
| Mailing Telephone | 9282309812 |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-01-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 333600000X | Pharmacy | S013695 | AZ | Suppliers |
| Street Address |
1980 MCCULLOCH BLVD N |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-0969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356604870 | Holly Vietor | Pharmacist | 1980 Mcculloch Blvd N, Lake Havasu City, AZ 86403-0969 | 2012-06-19 |
| 1730654856 | Mila Villa Haddox | Pharmacist | 1980 Mcculloch Blvd N, Lake Havasu City, AZ 86403-0969 | 2018-10-04 |
| 1346605185 | Albertsons LLC | Durable Medical Equipment & Medical Supplies | 1980 Mcculloch Blvd N, Lake Havasu City, AZ 86403-0969 | 2015-12-21 |
| 1194070391 | John P Harrington | Pharmacist | 1980 Mcculloch Blvd N, Lake Havasu City, AZ 86403-0969 | 2012-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083729008 | Bashas Inc | Pharmacy | 3269 Maricopa Ave, Ste 120, Lake Havasu City, AZ 86406-8593 | 2006-08-20 |
| 1821603994 | Arizona Cvs Stores | Pharmacy | 75 Lake Havasu Ave N, Lake Havasu City, AZ 86403-5651 | 2020-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386244861 | Canyonlands Community Healthcare | Pharmacy | 103 Fairgrounds Rd, Duncan, AZ 85534-8234 | 2020-10-26 |
| 1790384212 | Copilot Provider Support Services | Pharmacy | 8700 East Pinnacle Peak Road Ste 111, Johnson Bank Building, Scottsdale, AZ 85255-8525 | 2020-10-26 |
| 1366041501 | White Nile | Pharmacy | 4338 W Thomas Rd Unit E5, Phoenix, AZ 85031-3878 | 2020-10-20 |
| 1366050536 | Mariposa Community Health Center | Pharmacy | 1103 Circulo Mercado, Rio Rico, AZ 85648-6248 | 2020-07-14 |
| 1376169938 | Maricopa County Special Heallth Care District | Pharmacy | 2025 W Northern Ave, Phoenix, AZ 85021 | 2020-06-19 |
| 1952924847 | Cheryl Mackie | Pharmacy | 8010 E Mcdowell Rd Ste 201-206, Scottsdale, AZ 85257-3867 | 2020-05-26 |
| 1306472865 | Cordant Pharmacy Arizona, LLC | Pharmacy | 6641 E Baywood Ave Ste 101, Mesa, AZ 85206-1723 | 2020-03-17 |
| 1215575824 | Maricopa County Special Health Care District | Pharmacy | 8088 W Whitney Dr, Peoria, AZ 85345 | 2019-12-13 |
| 1811532609 | Nexus Patient Services | Pharmacy | 5080 N 40th St Ste 300, Phoenix, AZ 85018-2164 | 2019-11-15 |
| 1649813320 | Hi-health-rx LLC | Pharmacy | 15207 N 75th St Ste 105, Scottsdale, AZ 85260-2445 | 2019-10-24 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.