Healthcare Provider Details

I. General information

NPI: 1093707952
Provider Name (Legal Business Name): KELLEY SANDRA GRIFFITH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 AIRPORT RD
RIFLE CO
81650-8510
US

IV. Provider business mailing address

64 N PAINTED HORSE CIR
NEW CASTLE CO
81647-9494
US

V. Phone/Fax

Practice location:
  • Phone: 970-625-6440
  • Fax: 970-625-6467
Mailing address:
  • Phone: 970-984-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16606
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: