Provider Demographics
NPI:1417210360
Name:KELLER, JENNIFER WILLMOTT (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WILLMOTT
Last Name:KELLER
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 1:844 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-2140
Mailing Address - Country:US
Mailing Address - Phone:859-734-0082
Mailing Address - Fax:859-734-0084
Practice Address - Street 1:844 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-2140
Practice Address - Country:US
Practice Address - Phone:859-734-0082
Practice Address - Fax:859-734-0084
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist