Provider Demographics
NPI:1902439748
Name:DORFF, KELLEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLEN
Middle Name:
Last Name:DORFF
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 1:1500 W JAMES ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1001
Mailing Address - Country:US
Mailing Address - Phone:920-623-5459
Mailing Address - Fax:920-623-5462
Practice Address - Street 1:1500 W JAMES ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-1001
Practice Address - Country:US
Practice Address - Phone:920-623-5459
Practice Address - Fax:920-623-5462
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1907340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist