Provider Demographics
NPI:1144781659
Name:KELLER, KRISTI J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:J
Last Name:KELLER
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 1:2151 COUNTY ROAD C
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-4267
Mailing Address - Country:US
Mailing Address - Phone:402-366-3409
Mailing Address - Fax:
Practice Address - Street 1:905 2ND ST
Practice Address - Street 2:
Practice Address - City:FRIEND
Practice Address - State:NE
Practice Address - Zip Code:68359-1133
Practice Address - Country:US
Practice Address - Phone:402-947-2541
Practice Address - Fax:402-947-2811
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist