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General NPI Number Information
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NPI Number | 1063563138
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Entity Type | Individual
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Provider Name | JOHN L KELLER RPH
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 HWY 72ND WEST ROLLA HILLCREST SHOPPING CTR
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City | ROLLA
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State | MO
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Zip | 65401
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Country | US
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Telephone | 573-364-3258
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Fax | 573-341-2540
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Provider Business Mailing Address
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Address Line | PO BOX 669
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City | ROLLA
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State | MO
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Zip | 65402-0669
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Country | US
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Telephone | 573-364-6886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 027453
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License Number State | MO
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