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General NPI Number Information
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NPI Number | 1144536301
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Entity Type | Individual
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Provider Name | KIELEY ELIJAH COLLINS PHARM D
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Gender | Male
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 1585 SHERIDAN AVE
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City | CODY
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State | WY
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Zip | 82414-3819
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Country | US
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Telephone | 307-587-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 973 LANE 10 1/2
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City | LOVELL
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State | WY
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Zip | 82431-9608
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3383
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License Number State | WY
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