Provider Demographics
NPI:1811209976
Name:KELLER, JULIE C (RPH)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:C
Last Name:KELLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:C
Other - Last Name:LUKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2465 S FORREST HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-3541
Mailing Address - Country:US
Mailing Address - Phone:818-288-4230
Mailing Address - Fax:
Practice Address - Street 1:1825 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6497
Practice Address - Country:US
Practice Address - Phone:417-520-1745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 46118183500000X
MAPH 21618183500000X
MO2017034440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist