Provider Demographics
NPI:1316341092
Name:QAQISH, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:QAQISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-1645
Mailing Address - Country:US
Mailing Address - Phone:717-665-2223
Mailing Address - Fax:717-665-6362
Practice Address - Street 1:73 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-1645
Practice Address - Country:US
Practice Address - Phone:717-665-2223
Practice Address - Fax:717-665-6362
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI007832183500000X
PARP448130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist