Provider Demographics
NPI:1811270531
Name:WILLIS, KELLEE DANIELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:KELLEE
Middle Name:DANIELLE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KELLEE
Other - Middle Name:DANIELLE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1575 JEFFERSON RDG APT 7
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-0420
Mailing Address - Country:US
Mailing Address - Phone:909-809-2991
Mailing Address - Fax:
Practice Address - Street 1:2719 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2803
Practice Address - Country:US
Practice Address - Phone:785-587-8326
Practice Address - Fax:785-587-5221
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist