Provider Demographics
NPI:1720684277
Name:WEHAUSEN, KELLY KAY (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KAY
Last Name:WEHAUSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:KAY
Other - Last Name:SPREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2700 DOLBEER ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4799
Mailing Address - Country:US
Mailing Address - Phone:707-445-8121
Mailing Address - Fax:707-269-3731
Practice Address - Street 1:2700 DOLBEER ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4799
Practice Address - Country:US
Practice Address - Phone:707-445-8121
Practice Address - Fax:707-269-3731
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA697521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist