Provider Demographics
NPI:1154698272
Name:KINZER, KELLI ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANN
Last Name:KINZER
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 1:501 S MADISON ST STE S
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-2426
Mailing Address - Country:US
Mailing Address - Phone:417-673-2200
Mailing Address - Fax:417-673-2212
Practice Address - Street 1:501 S MADISON ST STE S
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-2426
Practice Address - Country:US
Practice Address - Phone:417-673-2200
Practice Address - Fax:417-673-2212
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044271183500000X
OK11298183500000X
KS1-11674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO329205OtherNABP