Provider Demographics
NPI:1871134015
Name:KRAUS, KELLY JO (RPH)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JO
Last Name:KRAUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 E 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5738
Mailing Address - Country:US
Mailing Address - Phone:219-947-3789
Mailing Address - Fax:
Practice Address - Street 1:3134 E 79TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5738
Practice Address - Country:US
Practice Address - Phone:219-947-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018001A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist