Provider Demographics
NPI:1205068558
Name:DORN, KELLI RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:RENEE
Last Name:DORN
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 1:29024 BELMONT FARM RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3778
Mailing Address - Country:US
Mailing Address - Phone:419-306-0921
Mailing Address - Fax:
Practice Address - Street 1:7643 PONDEROSA RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-4862
Practice Address - Country:US
Practice Address - Phone:419-661-2222
Practice Address - Fax:401-652-1576
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26031084A183500000X
OH03129379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist