Individual
MR. KEITH ALAN NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
626 GRAY FOX RD, BLUE EYE, MO 65611-8149
(417) 779-3008
(417) 779-3008
Mailing address
626 GRAY FOX RD, BLUE EYE, MO 65611-8149
(417) 779-3008
(417) 779-3008
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28997
MO
Other
Enumeration date
02/01/2008
Last updated
04/02/2014
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