Provider Demographics
NPI:1780230466
Name:KEILLOR, SCOTT PATRICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PATRICK
Last Name:KEILLOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 W WALKER WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-1336
Mailing Address - Country:US
Mailing Address - Phone:260-244-3113
Mailing Address - Fax:260-248-4267
Practice Address - Street 1:286 W WALKER WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-1336
Practice Address - Country:US
Practice Address - Phone:260-244-3113
Practice Address - Fax:260-248-4267
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025177A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist