Provider Demographics
NPI:1992018188
Name:KELLEY, CATHERINE A (RPH)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1650
Mailing Address - Country:US
Mailing Address - Phone:207-363-4312
Mailing Address - Fax:207-363-4986
Practice Address - Street 1:400 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1650
Practice Address - Country:US
Practice Address - Phone:207-363-4312
Practice Address - Fax:207-363-4986
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3319183500000X
NH2157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist