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General NPI Number Information
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NPI Number | 1316664691
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Entity Type | Individual
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Provider Name | ADAM DAVID KELLEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 1800 VANDALIA ST
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City | COLLINSVILLE
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State | IL
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Zip | 62234-4844
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Country | US
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Telephone | 618-344-8473
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Fax |
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Provider Business Mailing Address
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Address Line | 107 CHAPEL DR
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City | COLLINSVILLE
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State | IL
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Zip | 62234-4335
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Country | US
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Telephone | 815-780-7680
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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 | 051304940
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License Number State | IL
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