MEDICARE: DR. KELLY SUZANNE PFAFF PHARMD, RPH

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	03-2-28156	OH

General Provider Information

NPI Number	:	1497941777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY SUZANNE PFAFF PHARMD, RPH

Provider Business Mailing Address
First Line	:	393 SHALE RIDGE CT
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-7918
Country	:	US
Telephone Number	:	614-888-4982
Fax Number	:

Provider Business Practice Location Address
First Line	:	9110 DUBLIN RD
Second Line	:
City	:	SHAWNEE HILLS
State	:	OH
Zip	:	43065-9588
Country	:	US
Telephone Number	:	614-932-0303
Fax Number	:

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

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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