Provider Demographics
NPI:1912483280
Name:KEELEY, DON (RPH)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:KEELEY
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 1:4800 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5833
Mailing Address - Country:US
Mailing Address - Phone:309-690-3250
Mailing Address - Fax:309-690-3251
Practice Address - Street 1:4800 N UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5833
Practice Address - Country:US
Practice Address - Phone:309-690-3250
Practice Address - Fax:309-690-3251
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-037222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist