Provider Demographics
NPI:1033547542
Name:OFFORD, KELLI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:OFFORD
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 1:1304 CARRSBROOKE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-0969
Mailing Address - Country:US
Mailing Address - Phone:708-269-2174
Mailing Address - Fax:
Practice Address - Street 1:3220 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-5421
Practice Address - Country:US
Practice Address - Phone:708-756-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296930183500000X
IN26025291A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist