Provider Demographics
NPI:1497074587
Name:FERCHAK, KELLY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FERCHAK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLIAM MARKS WAY
Mailing Address - Street 2:
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1945
Mailing Address - Country:US
Mailing Address - Phone:412-461-4699
Mailing Address - Fax:412-461-6583
Practice Address - Street 1:100 WILLIAM MARKS WAY
Practice Address - Street 2:
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-1945
Practice Address - Country:US
Practice Address - Phone:412-461-4699
Practice Address - Fax:412-461-6583
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist