Provider Demographics
NPI:1447550942
Name:KELLOW, KEN III (PHARMD)
Entity type:Individual
Prefix:MR
First Name:KEN
Middle Name:
Last Name:KELLOW
Suffix:III
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 1:1550 HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-3405
Mailing Address - Country:US
Mailing Address - Phone:970-874-9091
Mailing Address - Fax:970-874-9092
Practice Address - Street 1:1550 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-3405
Practice Address - Country:US
Practice Address - Phone:970-874-9091
Practice Address - Fax:970-874-9092
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist