Provider Demographics
NPI:1407139926
Name:KEELING, JEFFREY A (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:KEELING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 STELLHORN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5349
Mailing Address - Country:US
Mailing Address - Phone:260-485-0755
Mailing Address - Fax:260-486-7531
Practice Address - Street 1:6201 STELLHORN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5349
Practice Address - Country:US
Practice Address - Phone:260-485-0755
Practice Address - Fax:260-486-7531
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013946A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist