Provider Demographics
NPI:1992006068
Name:KEELER, EVERETT ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:EVERETT
Middle Name:ANTHONY
Last Name:KEELER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 POST ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-4062
Mailing Address - Country:US
Mailing Address - Phone:541-259-5706
Mailing Address - Fax:541-259-5708
Practice Address - Street 1:1983 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3142
Practice Address - Country:US
Practice Address - Phone:541-259-5706
Practice Address - Fax:541-259-5708
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR57071835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric