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General NPI Number Information
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NPI Number | 1780230466
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Entity Type | Individual
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Provider Name | SCOTT PATRICK KEILLOR PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2019
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Last Update Date | 08/17/2019
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Provider Practice Location Address
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Address Line | 286 W WALKER WAY
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City | COLUMBIA CITY
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State | IN
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Zip | 46725-1336
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Country | US
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Telephone | 260-244-3113
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Fax | 260-248-4267
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Provider Business Mailing Address
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Address Line | 286 W WALKER WAY
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City | COLUMBIA CITY
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State | IN
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Zip | 46725-1336
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Country | US
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Telephone | 260-244-3113
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Fax | 260-248-4267
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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 | 26025177A
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License Number State | IN
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