Provider Demographics
NPI:1992303879
Name:KEELING, VERNER TERRELL (PHARMACIST)
Entity type:Individual
Prefix:
First Name:VERNER
Middle Name:TERRELL
Last Name:KEELING
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 TOWNE LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5520
Mailing Address - Country:US
Mailing Address - Phone:770-517-2088
Mailing Address - Fax:779-517-2090
Practice Address - Street 1:2295 TOWNE LAKE PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5520
Practice Address - Country:US
Practice Address - Phone:770-517-2088
Practice Address - Fax:770-517-2090
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist