Provider Demographics
NPI:1952675076
Name:KELLER, DEBRA KAY (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:KELLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29117 N DALTON RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-9811
Mailing Address - Country:US
Mailing Address - Phone:098-637-9935
Mailing Address - Fax:
Practice Address - Street 1:412 S MAIN
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006
Practice Address - Country:US
Practice Address - Phone:509-276-9016
Practice Address - Fax:509-276-8890
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00018323OtherSTATE PHARMACIST LICENSE