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General NPI Number Information
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NPI Number | 1568059079
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Entity Type | Organization
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Legal Business Name | KELLER PHARMACY
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 101 WEST 3RD ST
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City | PONCA
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State | NE
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Zip | 68770-6877
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Country | US
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Telephone | 402-755-2216
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 365
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City | PONCA
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State | NE
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Zip | 68770-0365
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Country | US
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Telephone | 402-755-2216
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | CHRISTOPHER KELLER
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Credential |
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Telephone | 402-755-2216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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