Provider Demographics
NPI:1326425885
Name:STAUFFER, KELLIE (RPH)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:STAUFFER
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 1:908 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2219
Mailing Address - Country:US
Mailing Address - Phone:777-892-3566
Mailing Address - Fax:717-367-3772
Practice Address - Street 1:191 RIDGEVIEW RD S
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022
Practice Address - Country:US
Practice Address - Phone:717-367-2212
Practice Address - Fax:717-367-3772
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040984L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist