Healthcare Provider Details

I. General information

NPI: 1407779689
Provider Name (Legal Business Name): KELLY SANFILIPPO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 SCREECH OWL RD
WAXHAW NC
28173-7171
US

IV. Provider business mailing address

1417 SCREECH OWL RD
WAXHAW NC
28173-7171
US

V. Phone/Fax

Practice location:
  • Phone: 516-443-3216
  • Fax:
Mailing address:
  • Phone: 516-443-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number040828
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: