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General NPI Number Information
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NPI Number | 1477981694
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Entity Type | Individual
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Provider Name | KELLY GALEN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/25/2013
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 833 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60612-7229
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Country | US
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Telephone | 314-757-0775
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Fax |
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Provider Business Mailing Address
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Address Line | 9748 GRANTVIEW FOREST DR
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City | SAINT LOUIS
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State | MO
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Zip | 63123-3953
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Country | US
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Telephone | 314-757-0775
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 051296770
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License Number State | IL
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