Provider Demographics
NPI:1689953986
Name:KELKENBERG, AMBER MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:KELKENBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-3509
Mailing Address - Country:US
Mailing Address - Phone:716-523-7823
Mailing Address - Fax:
Practice Address - Street 1:408 WEST AVE
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1525
Practice Address - Country:US
Practice Address - Phone:585-589-2611
Practice Address - Fax:585-589-2568
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0055853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist