Provider Demographics
NPI:1124553946
Name:CHAN, KELLEY LYNNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:LYNNE
Last Name:CHAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9285 ELK GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2101
Mailing Address - Country:US
Mailing Address - Phone:916-714-5372
Mailing Address - Fax:916-714-5427
Practice Address - Street 1:9285 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2101
Practice Address - Country:US
Practice Address - Phone:916-714-5372
Practice Address - Fax:916-714-5427
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist