Provider Demographics
NPI:1841569654
Name:KELLER, JONATHAN A (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:A
Last Name:KELLER
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 1:38 JENSEN ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2843
Mailing Address - Country:US
Mailing Address - Phone:732-528-8161
Mailing Address - Fax:732-528-0507
Practice Address - Street 1:2433 HIGHWAY #34
Practice Address - Street 2:SHOPRITE PHARMACY
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-528-8161
Practice Address - Fax:732-528-0507
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03362400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist