Provider Demographics
NPI:1033521877
Name:SANZEN, KELLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:SANZEN
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 1:92 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-5563
Mailing Address - Country:US
Mailing Address - Phone:401-480-4758
Mailing Address - Fax:
Practice Address - Street 1:17 VIRGINIA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4406
Practice Address - Country:US
Practice Address - Phone:401-784-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010274183500000X
RIRPH043831835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist