Provider Demographics
NPI:1447896220
Name:KELLAR, MARCI (PHARMD)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:KELLAR
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 1:8250 RIDGE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-9559
Mailing Address - Country:US
Mailing Address - Phone:317-752-2541
Mailing Address - Fax:
Practice Address - Street 1:150 W 161ST ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8565
Practice Address - Country:US
Practice Address - Phone:317-867-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021152A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist