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General NPI Number Information
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NPI Number | 1477843282
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Entity Type | Individual
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Provider Name | KEITH LINCOLN KELLER M.D., R.PH.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | IHS PINE RIDGE SERVICE UNIT HWY 18
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City | PINE RIDGE
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State | SD
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Zip | 57770
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Country | US
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Telephone | 605-867-3195
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 203
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City | PINE RIDGE
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State | SD
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Zip | 57770-0203
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Country | US
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Telephone | 402-238-4913
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 11551
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 10573
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16677
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 145651-1701
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License Number State | UT
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