Provider Demographics
NPI:1528692019
Name:KELLING, ELIZABETH CATHERINE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CATHERINE
Last Name:KELLING
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 1:1029 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3813
Mailing Address - Country:US
Mailing Address - Phone:920-458-7707
Mailing Address - Fax:
Practice Address - Street 1:1029 N 14TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3813
Practice Address - Country:US
Practice Address - Phone:920-458-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1135351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist