Healthcare Provider Details

I. General information

NPI: 1245767045
Provider Name (Legal Business Name): KEITH MELE PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEITH MELE PHARM.D

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7457 WEINER STREET
HILL AIR FORCE BASE UT
84056
US

IV. Provider business mailing address

7414 ELGIN AVE APT # 14B
LUBBOCK TX
79423
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-2533
  • Fax:
Mailing address:
  • Phone: 385-216-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number367928-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: