Provider Demographics
NPI:1952696239
Name:SCHAEFER, KELLY P (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:P
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 NW 36TH CT
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-2075
Mailing Address - Country:US
Mailing Address - Phone:515-964-7000
Mailing Address - Fax:515-964-7000
Practice Address - Street 1:9030 NW 36TH CT
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-2075
Practice Address - Country:US
Practice Address - Phone:515-964-7000
Practice Address - Fax:515-964-7000
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21311183500000X
MO2007022470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist