Provider Demographics
NPI:1477548907
Name:WERSC HEY, KELLIE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANN
Last Name:WERSC HEY
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 1:4142 BRIDGEWATER PKWY
Mailing Address - Street 2:APT. 101
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6106
Mailing Address - Country:US
Mailing Address - Phone:216-694-4629
Mailing Address - Fax:
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-694-4629
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-24781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist