Healthcare Provider Details

I. General information

NPI: 1093029159
Provider Name (Legal Business Name): KELLY A DOLON PHARMD., MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2010
Last Update Date: 07/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 TORRESDALE AVE
PHILADELPHIA PA
19135-3303
US

IV. Provider business mailing address

6327 TORRESDALE AVE
PHILADELPHIA PA
19135-3303
US

V. Phone/Fax

Practice location:
  • Phone: 215-331-9929
  • Fax: 215-331-9885
Mailing address:
  • Phone: 215-331-9929
  • Fax: 215-331-9885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberF1541123
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: