Provider Demographics
NPI:1952519282
Name:KELLER CLEMENS, MAGDELINE BARBARA (RPH)
Entity Type:Individual
Prefix:MS
First Name:MAGDELINE
Middle Name:BARBARA
Last Name:KELLER CLEMENS
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 1:137 ELIZABETH CIR
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-9594
Mailing Address - Country:US
Mailing Address - Phone:252-232-0444
Mailing Address - Fax:
Practice Address - Street 1:1144 N ROAD ST
Practice Address - Street 2:ALBEMARLE HOSPITAL
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3353
Practice Address - Country:US
Practice Address - Phone:252-384-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216460183500000X
DEA10002155183500000X
VA0202009940183500000X
NC17838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist