Provider Demographics
NPI:1023036399
Name:KELLER, PATRICIA B (DPH)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:B
Last Name:KELLER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:1907 LAKE ROAD
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38025-0726
Mailing Address - Country:US
Mailing Address - Phone:731-286-0648
Mailing Address - Fax:731-286-0648
Practice Address - Street 1:625 W MAIN ST # WEST
Practice Address - Street 2:SUITE D
Practice Address - City:NEWBERN
Practice Address - State:TN
Practice Address - Zip Code:38059-1572
Practice Address - Country:US
Practice Address - Phone:731-627-9573
Practice Address - Fax:731-627-3051
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist