Healthcare Provider Details

I. General information

NPI: 1871512277
Provider Name (Legal Business Name): SUZANNE KELLEY RPH, CPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

2299 SCENIC HWY #R-7
PENSACOLA FL
32503-6604
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-5638
  • Fax:
Mailing address:
  • Phone: 850-433-2155
  • Fax: 850-202-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS20043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: