Provider Demographics
NPI:1578844817
Name:KELLER, TIMOTHY EUGENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:EUGENE
Last Name:KELLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ROUNDWOOD DR
Mailing Address - Street 2:WALGREENS DISTRICT OFFICE
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8259
Mailing Address - Country:US
Mailing Address - Phone:207-885-9365
Mailing Address - Fax:207-885-9367
Practice Address - Street 1:600 ROUNDWOOD DR
Practice Address - Street 2:WALGREENS DISTRICT OFFICE
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8259
Practice Address - Country:US
Practice Address - Phone:207-885-9365
Practice Address - Fax:207-885-9367
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5978183500000X
MD13519183500000X
NHR2226183500000X
PARP046449R183500000X
DEA10002793183500000X
IL051.294479183500000X
PARPI10017351835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist