Individual
MR. KELLY LOUIS MARLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
6525 N ILLINOIS ST, FAIRVIEW HEIGHTS, IL 62208-2001
(618) 397-2091
Mailing address
2202 PULLIAM AVE, FAYETTEVILLE, IL 62258-5010
(618) 677-2296
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051-037464
IL
Other
Enumeration date
02/05/2010
Last updated
02/05/2010
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