Provider Demographics
NPI:1295002251
Name:KELLER, JAMIE L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
Last Name:KELLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:150 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-1001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-1001
Practice Address - Country:US
Practice Address - Phone:716-693-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist