Provider Demographics
NPI:1265163471
Name:KECK, CHRISTOPHER HARRIS (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:HARRIS
Last Name:KECK
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 1:920 MOREHEAD ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2548
Mailing Address - Country:US
Mailing Address - Phone:251-581-4687
Mailing Address - Fax:
Practice Address - Street 1:607 INDIAN HEALTH RD
Practice Address - Street 2:
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-3169
Practice Address - Country:US
Practice Address - Phone:605-867-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-19
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist