Provider Demographics
NPI:1801342282
Name:SCHAFER, KELLI DAWN (RPH)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:DAWN
Last Name:SCHAFER
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 1:9400 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4520
Mailing Address - Country:US
Mailing Address - Phone:440-255-6247
Mailing Address - Fax:440-255-7203
Practice Address - Street 1:9400 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4520
Practice Address - Country:US
Practice Address - Phone:440-255-6247
Practice Address - Fax:440-255-7203
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-19539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist