Healthcare Provider Details

I. General information

NPI: 1306952502
Provider Name (Legal Business Name): DANIEL P. KELLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W UNIVERSITY DR
ROCHESTER MI
48307-1987
US

IV. Provider business mailing address

118 W UNIVERSITY DR
ROCHESTER MI
48307-1987
US

V. Phone/Fax

Practice location:
  • Phone: 248-651-4044
  • Fax: 248-651-4046
Mailing address:
  • Phone: 248-651-4044
  • Fax: 248-651-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301001437
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANIEL KELLER
Title or Position: OWNER
Credential:
Phone: 248-651-4044