MEDICARE: KELLY K CHILLINGWORTH RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	048559-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285814343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY K CHILLINGWORTH RPH

Provider Business Mailing Address
First Line	:	6952 LAKESIDE DR
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-4686
Country	:	US
Telephone Number	:	716-731-2133
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 NIAGARA FALLS BLVD
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-4759
Country	:	US
Telephone Number	:	716-693-9666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	11/06/2007

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