=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740538826
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY CALUORI PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2012
-----------------------------------------------------
Last Update Date | 02/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 SPRINGDALE ST
-----------------------------------------------------
City | MOUNT HOREB
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53572-2067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-437-9160
-----------------------------------------------------
Fax | 608-437-9166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 SPRINGDALE ST
-----------------------------------------------------
City | MOUNT HOREB
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53572-2067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-437-9160
-----------------------------------------------------
Fax | 608-437-9166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 16773-40
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------