Provider Demographics
NPI:1477843282
Name:KELLER, KEITH LINCOLN (MD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LINCOLN
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-0203
Mailing Address - Country:US
Mailing Address - Phone:402-238-4913
Mailing Address - Fax:
Practice Address - Street 1:IHS PINE RIDGE SERVICE UNIT
Practice Address - Street 2:HWY 18
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770
Practice Address - Country:US
Practice Address - Phone:605-867-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO115511835P0018X
NE105731835P0018X
NE16677207Q00000X
UT145651-17011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine