Provider Demographics
NPI:1134834054
Name:KAISER, KALLI NICOLE (RPH)
Entity type:Individual
Prefix:DR
First Name:KALLI
Middle Name:NICOLE
Last Name:KAISER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-4300
Mailing Address - Country:US
Mailing Address - Phone:218-385-3360
Mailing Address - Fax:218-385-4535
Practice Address - Street 1:99 MILLER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567-4300
Practice Address - Country:US
Practice Address - Phone:210-385-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist