Provider Demographics
NPI:1649851965
Name:KELLEHER, DANA LEE (RPH)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LEE
Last Name:KELLEHER
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 1:311 ELMWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RIEGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18077-7021
Mailing Address - Country:US
Mailing Address - Phone:610-663-5776
Mailing Address - Fax:
Practice Address - Street 1:311 ELMWOOD LN
Practice Address - Street 2:
Practice Address - City:RIEGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18077-7021
Practice Address - Country:US
Practice Address - Phone:610-663-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037981L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist