Healthcare Provider Details

I. General information

NPI: 1922380690
Provider Name (Legal Business Name): KELI D DAILEY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 PAWNEE ST
CLINTON MO
64735-2481
US

IV. Provider business mailing address

412 PAWNEE ST
CLINTON MO
64735-2481
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-4020
  • Fax: 660-885-4095
Mailing address:
  • Phone: 660-885-4020
  • Fax: 660-885-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2011004179
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD11393
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: