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General NPI Number Information
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NPI Number | 1912528423
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Entity Type | Individual
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Provider Name | KEVIN KELLER II PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 1221 GEORGESVILLE RD
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City | COLUMBUS
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State | OH
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Zip | 43228-3327
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Country | US
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Telephone | 614-275-9832
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Fax |
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Provider Business Mailing Address
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Address Line | 3026 KILCULLEN DR
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City | COLUMBUS
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State | OH
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Zip | 43221-4540
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Country | US
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Telephone | 419-450-6863
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03230391
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License Number State | OH
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