Provider Demographics
NPI:1326355124
Name:KELLEY, AMBER L (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:KELLEY
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 1:10186 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-8087
Mailing Address - Country:US
Mailing Address - Phone:563-588-9097
Mailing Address - Fax:563-588-2453
Practice Address - Street 1:2600 DODGE ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7159
Practice Address - Country:US
Practice Address - Phone:563-588-9097
Practice Address - Fax:563-588-2453
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist