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NPI Code Detail

MEDICARE: THERESA KELLAR PHARM.D.

MEDICARE: THERESA KELLAR PHARM.D.
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
1183500000XPharmacist014673KY

General Provider Information

NPI Number : 1790066140
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA KELLAR PHARM.D.
Provider Business Mailing Address
First Line : 200 E BROADWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-2008
Country : US
Telephone Number : 502-568-4864
Fax Number : 502-568-9077
Provider Business Practice Location Address
First Line : 200 E BROADWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-2008
Country : US
Telephone Number : 502-568-4864
Fax Number : 502-568-9077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2011
Last Update Date : 08/30/2011

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Directions to “ THERESA KELLAR PHARM.D.” Practice Location

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