Provider Demographics
NPI:1568059079
Name:KELLER PHARMACY
Entity Type:Organization
Organization Name:KELLER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-755-2216
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:PONCA
Mailing Address - State:NE
Mailing Address - Zip Code:68770-0365
Mailing Address - Country:US
Mailing Address - Phone:402-755-2216
Mailing Address - Fax:
Practice Address - Street 1:101 WEST 3RD ST
Practice Address - Street 2:
Practice Address - City:PONCA
Practice Address - State:NE
Practice Address - Zip Code:68770-6877
Practice Address - Country:US
Practice Address - Phone:402-755-2216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy