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NPI Code Detail

MEDICARE: MR. DENNIS ROBERT KELLMAN RPH

MEDICARE: MR. DENNIS ROBERT KELLMAN 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
1183500000XPharmacist051-289296IL

General Provider Information

NPI Number : 1548560444
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DENNIS ROBERT KELLMAN RPH
Provider Business Mailing Address
First Line : 2550 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1941
Country : US
Telephone Number : 773-935-9610
Fax Number :
Provider Business Practice Location Address
First Line : 2550 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1941
Country : US
Telephone Number : 773-935-9610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2010
Last Update Date : 10/25/2010

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