Provider Demographics
NPI:1184718264
Name:BLAIR-BURKHOLDER, KEELEY A (RPH)
Entity type:Individual
Prefix:
First Name:KEELEY
Middle Name:A
Last Name:BLAIR-BURKHOLDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6713 W 95TH PL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-6436
Mailing Address - Country:US
Mailing Address - Phone:303-425-2222
Mailing Address - Fax:
Practice Address - Street 1:6713 W 95TH PL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-6436
Practice Address - Country:US
Practice Address - Phone:303-425-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist