Provider Demographics
NPI:1063004471
Name:MORLAND, KELLIE DUDASH (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:DUDASH
Last Name:MORLAND
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 1:7 BAYLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9203
Mailing Address - Country:US
Mailing Address - Phone:412-657-1410
Mailing Address - Fax:
Practice Address - Street 1:7 BAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9203
Practice Address - Country:US
Practice Address - Phone:412-657-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist