Basic Information
| Provider Information | |||||||||
| NPI: | 1477843282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLER | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | LINCOLN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 203 | ||||||||
| Address2: | |||||||||
| City: | PINE RIDGE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577700203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4022384913 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | IHS PINE RIDGE SERVICE UNIT | ||||||||
| Address2: | HWY 18 | ||||||||
| City: | PINE RIDGE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058673195 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2011 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 11551 | CO | N | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 10573 | NE | N | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 207Q00000X | 16677 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine | 1835P0018X | 145651-1701 | UT | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.