Provider Demographics
NPI:1346857737
Name:KELEHER, EMILY MARIE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:KELEHER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MARIE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:1000 SAGAMORE PKWY W
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1446
Practice Address - Country:US
Practice Address - Phone:765-497-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN262028486A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist