Healthcare Provider Details

I. General information

NPI: 1760483119
Provider Name (Legal Business Name): SHELLIE LUCILLE KEAST D.PH., PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 NE 13TH ST ORI-W4403
OKLAHOMA CITY OK
73117-1039
US

IV. Provider business mailing address

1625 NW 31ST ST
OKLAHOMA CITY OK
73118-3611
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-9039
  • Fax: 405-271-6002
Mailing address:
  • Phone: 405-826-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12716
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: