Provider Demographics
NPI:1114541950
Name:IMFELD, KELLEY (PHARMD)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:IMFELD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 BROADWAY APT 404
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3395
Mailing Address - Country:US
Mailing Address - Phone:732-832-1697
Mailing Address - Fax:
Practice Address - Street 1:2 MYSTIC VIEW RD
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-2428
Practice Address - Country:US
Practice Address - Phone:618-544-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-06
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist