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General NPI Number Information
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NPI Number | 1215410188
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Entity Type | Individual
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Provider Name | BARRY LYNN KEELER
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Gender | Male
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | DOMINICAN PLAZA PHARMACY 1595 SOQUEL DR SUITE 120
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City | SANTA CRUZ
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State | CA
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Zip | 95065
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Country | US
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Telephone | 831-462-7726
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Fax | 831-462-7615
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Provider Business Mailing Address
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Address Line | 3096 W LEDYARD WAY
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City | APTOS
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State | CA
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Zip | 95003-3829
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Country | US
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Telephone | 831-234-0322
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 29416
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License Number State | CA
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