Provider Demographics
NPI:1760483119
Name:KEAST, SHELLIE LUCILLE (DPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLIE
Middle Name:LUCILLE
Last Name:KEAST
Suffix:
Gender:F
Credentials:DPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 NW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-3611
Mailing Address - Country:US
Mailing Address - Phone:405-826-1764
Mailing Address - Fax:
Practice Address - Street 1:1122 NE 13TH ST
Practice Address - Street 2:ORI-W4403
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1039
Practice Address - Country:US
Practice Address - Phone:405-271-9039
Practice Address - Fax:405-271-6002
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK127161835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy