Provider Demographics
NPI:1245510833
Name:FAIRCHILD, KELLI (PHARMD)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:FAIRCHILD
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 1:1750 PRIDE LN
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-7708
Mailing Address - Country:US
Mailing Address - Phone:507-320-0542
Mailing Address - Fax:
Practice Address - Street 1:703 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2937
Practice Address - Country:US
Practice Address - Phone:507-369-0260
Practice Address - Fax:507-369-0266
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist