Provider Demographics
NPI:1548694409
Name:KELLER, CHADRICK DONAVON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHADRICK
Middle Name:DONAVON
Last Name:KELLER
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 1:1471 ROBERT ST S
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3141
Mailing Address - Country:US
Mailing Address - Phone:701-426-1374
Mailing Address - Fax:
Practice Address - Street 1:1471 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3141
Practice Address - Country:US
Practice Address - Phone:651-552-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist