Provider Demographics
NPI:1689974057
Name:KEEL, JERRY DON (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:DON
Last Name:KEEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 S OLSON ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2241
Mailing Address - Country:US
Mailing Address - Phone:509-783-5587
Mailing Address - Fax:
Practice Address - Street 1:2825 W KENNEWICK AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2927
Practice Address - Country:US
Practice Address - Phone:509-783-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00007943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist