Healthcare Provider Details

I. General information

NPI: 1447533799
Provider Name (Legal Business Name): HEIDI BLASIO KELLER PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 GAUSE BLVD
SLIDELL LA
70458-3015
US

IV. Provider business mailing address

100 CHARLES CT
SLIDELL LA
70458-9119
US

V. Phone/Fax

Practice location:
  • Phone: 985-641-2550
  • Fax: 985-641-5765
Mailing address:
  • Phone: 504-388-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number017944
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: