Provider Demographics
NPI:1720410939
Name:DUNNIGAN, KELLEY MARIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:MARIE
Last Name:DUNNIGAN
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 1:463 ALBANY SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1833
Mailing Address - Country:US
Mailing Address - Phone:518-458-1205
Mailing Address - Fax:518-591-0209
Practice Address - Street 1:463 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1833
Practice Address - Country:US
Practice Address - Phone:518-458-1205
Practice Address - Fax:518-591-0209
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist