Provider Demographics
NPI:1508183815
Name:CREANGE, KELLI (RPH)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:CREANGE
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 1:874 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5678
Mailing Address - Country:US
Mailing Address - Phone:732-929-8825
Mailing Address - Fax:732-929-8880
Practice Address - Street 1:702 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAVALLETTE
Practice Address - State:NJ
Practice Address - Zip Code:08735-2214
Practice Address - Country:US
Practice Address - Phone:732-793-1910
Practice Address - Fax:732-793-8582
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02485600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist