Healthcare Provider Details

I. General information

NPI: 1689953986
Provider Name (Legal Business Name): AMBER MARIE KELKENBERG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 WEST AVE
ALBION NY
14411-1525
US

IV. Provider business mailing address

7717 CHESTNUT RIDGE RD
LOCKPORT NY
14094-3509
US

V. Phone/Fax

Practice location:
  • Phone: 585-589-2611
  • Fax: 585-589-2568
Mailing address:
  • Phone: 716-523-7823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0055853
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: