Provider Demographics
NPI:1558762369
Name:KELLEHER, JOHN BRICKLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRICKLEY
Last Name:KELLEHER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-2110
Mailing Address - Country:US
Mailing Address - Phone:559-308-3202
Mailing Address - Fax:559-739-8916
Practice Address - Street 1:616 E BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292
Practice Address - Country:US
Practice Address - Phone:559-308-3202
Practice Address - Fax:559-739-8916
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA039260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist