Provider Demographics
NPI:1457974701
Name:KELLER, RYAN BLAKE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BLAKE
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 1:1650 MURFREESBORO RD STE 130
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5095
Mailing Address - Country:US
Mailing Address - Phone:615-814-2911
Mailing Address - Fax:
Practice Address - Street 1:1650 MURFREESBORO RD STE 130
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5095
Practice Address - Country:US
Practice Address - Phone:615-814-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000042496183500000X
VA0202206188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist