Provider Demographics
NPI:1235333097
Name:O'NEAL, KEELY J (RPH)
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:J
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 LAMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-4607
Mailing Address - Country:US
Mailing Address - Phone:806-353-5380
Mailing Address - Fax:
Practice Address - Street 1:701 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-5279
Practice Address - Country:US
Practice Address - Phone:806-376-8245
Practice Address - Fax:806-379-7514
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist