Provider Demographics
NPI:1063822922
Name:KELLAR, CHAUNTEL NICOLE RENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHAUNTEL
Middle Name:NICOLE RENE
Last Name:KELLAR
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 1:1600 W LA JOLLA DR
Mailing Address - Street 2:APT 2033
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4430
Mailing Address - Country:US
Mailing Address - Phone:504-957-3534
Mailing Address - Fax:
Practice Address - Street 1:1600 W LA JOLLA DR
Practice Address - Street 2:APT 2033
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4430
Practice Address - Country:US
Practice Address - Phone:504-957-3534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ019974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist