Edward Paul Kellermann, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

040206 Issued in NY

Practice address

325 Route 110
Huntington Station, NY 11746-4149

Phone

(631) 271-2525

NPI assigned

Nov 24, 2007

Last updated

Nov 24, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195862400000",
    "number": "1447431028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 ROUTE 110",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117464149",
            "telephone_number": "631-271-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 ROUTE 110",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117464149",
            "telephone_number": "631-271-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLERMANN",
        "first_name": "EDWARD",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-24",
        "last_updated": "2007-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "040206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01562505",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Huntington Station, NY
• Providers in Huntington Station, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.