Provider Demographics
NPI:1508149394
Name:KELLER, DANIEL W (PHARM D)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:KELLER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6464 MILHAVEN AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-9694
Mailing Address - Country:US
Mailing Address - Phone:330-284-9464
Mailing Address - Fax:
Practice Address - Street 1:2012 S UNION AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4951
Practice Address - Country:US
Practice Address - Phone:330-829-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist