Provider Demographics
NPI:1194146522
Name:ANDERSON, KELLIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:
Last Name:ANDERSON
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 1:582 RAVENNA CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6931
Mailing Address - Country:US
Mailing Address - Phone:563-508-2435
Mailing Address - Fax:
Practice Address - Street 1:237 S 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3601
Practice Address - Country:US
Practice Address - Phone:970-242-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292583183500000X
MN121631183500000X
COPHA.0021622183500000X
IA20816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist