Provider Demographics
NPI:1851790760
Name:ELY, KATELYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:ELY
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 1:1845 GRANDSTAND PL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6603
Mailing Address - Country:US
Mailing Address - Phone:224-276-7236
Mailing Address - Fax:224-276-6544
Practice Address - Street 1:1845 GRANDSTAND PL
Practice Address - Street 2:SUITE 300
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-6603
Practice Address - Country:US
Practice Address - Phone:224-276-7236
Practice Address - Fax:224-276-6544
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist