Provider Demographics
NPI:1861776536
Name:CASTALDO, KELLY (PHARM D)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CASTALDO
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 1:3701 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3838
Mailing Address - Country:US
Mailing Address - Phone:414-482-1470
Mailing Address - Fax:414-482-9658
Practice Address - Street 1:3701 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-3838
Practice Address - Country:US
Practice Address - Phone:414-482-1470
Practice Address - Fax:414-482-9658
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14572-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist