| NPI | 1659533248 |
|---|---|
| Former Name | KELLIE VAVRA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302035024) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 18090) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2015-02-10 |