Provider Demographics
NPI:1497941777
Name:PFAFF, KELLY SUZANNE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SUZANNE
Last Name:PFAFF
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 SHALE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7918
Mailing Address - Country:US
Mailing Address - Phone:614-888-4982
Mailing Address - Fax:
Practice Address - Street 1:9110 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE HILLS
Practice Address - State:OH
Practice Address - Zip Code:43065-9588
Practice Address - Country:US
Practice Address - Phone:614-932-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-28156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist