Provider Demographics
NPI:1538764477
Name:KALTENBACH, ELLEN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:KALTENBACH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 FOOTHILLS RD
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24067-5402
Mailing Address - Country:US
Mailing Address - Phone:540-420-0633
Mailing Address - Fax:
Practice Address - Street 1:970 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1276
Practice Address - Country:US
Practice Address - Phone:540-483-0258
Practice Address - Fax:540-484-1039
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011655183500000X
VA0202013099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist