Provider Demographics
NPI:1780143461
Name:KELLER, ANNA TERESA (PHARMD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:TERESA
Last Name:KELLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:TERESA
Other - Last Name:HRYWNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9016 W HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-2876
Mailing Address - Country:US
Mailing Address - Phone:440-785-5460
Mailing Address - Fax:
Practice Address - Street 1:1810 SUMMIT COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2300
Practice Address - Country:US
Practice Address - Phone:800-321-0591
Practice Address - Fax:614-652-7936
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5759183500000X
LA021942183500000X
AL20255183500000X
NE15560183500000X
TX61706183500000X
OH03326690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist