Provider Demographics
NPI:1033501515
Name:KEELY, STEPHANIE NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:KEELY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COMPASS CT
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:OH
Mailing Address - Zip Code:45157-8587
Mailing Address - Country:US
Mailing Address - Phone:513-708-6102
Mailing Address - Fax:
Practice Address - Street 1:4394 EASTGATE SQUARE DR # 4350
Practice Address - Street 2:500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1595
Practice Address - Country:US
Practice Address - Phone:513-943-6340
Practice Address - Fax:513-752-6525
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132209183500000X
KY016139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist