Provider Demographics
NPI:1043524002
Name:QUAILE, KELLI ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANN
Last Name:QUAILE
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 1:5 SOUTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4807
Mailing Address - Country:US
Mailing Address - Phone:856-753-7387
Mailing Address - Fax:
Practice Address - Street 1:1410 LAUREL RD
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-3760
Practice Address - Country:US
Practice Address - Phone:856-346-1616
Practice Address - Fax:856-346-9578
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02760100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist