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General NPI Number Information
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NPI Number | 1306952502
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Entity Type | Organization
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Legal Business Name | DANIEL P. KELLER
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 118 W UNIVERSITY DR
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City | ROCHESTER
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State | MI
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Zip | 48307-1987
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Country | US
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Telephone | 248-651-4044
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Fax | 248-651-4046
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Provider Business Mailing Address
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Address Line | 118 W UNIVERSITY DR
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City | ROCHESTER
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State | MI
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Zip | 48307-1987
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Country | US
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Telephone | 248-651-4044
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Fax | 248-651-4046
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL KELLER
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Credential |
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Telephone | 248-651-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301001437
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License Number State | MI
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