Healthcare Provider Details

I. General information

NPI: 1417874892
Provider Name (Legal Business Name): MEGAN ANNE KELLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 PARKVIEW PLAZA DR
FORT WAYNE IN
46845-1701
US

IV. Provider business mailing address

2814 SANDPOINT RD
FORT WAYNE IN
46809-1831
US

V. Phone/Fax

Practice location:
  • Phone: 734-634-4272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number26031940A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: