MEDICARE: DR. KELLEN ELAYNE DANLEY PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS55321	FL

General Provider Information

NPI Number	:	1316418197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLEN ELAYNE DANLEY PHARMD

Provider Business Mailing Address
First Line	:	11334 LAKELAND CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-6913
Country	:	US
Telephone Number	:	239-789-7784
Fax Number	:

Provider Business Practice Location Address
First Line	:	12401 COMMERCE LAKES DR UNIT C
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-8663
Country	:	US
Telephone Number	:	239-789-7784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	12/05/2018

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