Provider Demographics
NPI:1871512277
Name:KELLEY, SUZANNE (RPH, CPH)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RPH, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 SCENIC HWY
Mailing Address - Street 2:#R-7
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-6604
Mailing Address - Country:US
Mailing Address - Phone:850-433-2155
Mailing Address - Fax:850-202-0600
Practice Address - Street 1:5041 NORTH 12TH AVENUE
Practice Address - Street 2:COVENANT HOSPICE
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-433-2155
Practice Address - Fax:850-202-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist