Provider Demographics
NPI:1578167557
Name:KELLER, RICHARD ALLEN
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:KELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 HARRISBURG AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2615
Mailing Address - Country:US
Mailing Address - Phone:717-391-9503
Mailing Address - Fax:717-391-9508
Practice Address - Street 1:551 HARRISBURG AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2615
Practice Address - Country:US
Practice Address - Phone:717-391-9503
Practice Address - Fax:717-391-9508
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-036665-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist