Provider Demographics
NPI:1942783576
Name:KELLER, ALEXANDRA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:HABERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:80 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1412
Mailing Address - Country:US
Mailing Address - Phone:716-392-7871
Mailing Address - Fax:
Practice Address - Street 1:1275 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-2126
Practice Address - Country:US
Practice Address - Phone:716-816-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist