Healthcare Provider Details

I. General information

NPI: 1841553989
Provider Name (Legal Business Name): KELLY JEAN KRIEGER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 BAILEY AVE
BUFFALO NY
14215-1129
US

IV. Provider business mailing address

1512 E ETON DR
ARLINGTON HEIGHTS IL
60004-2185
US

V. Phone/Fax

Practice location:
  • Phone: 716-834-9200
  • Fax:
Mailing address:
  • Phone: 847-452-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051.294536
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number051.294536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: