Provider Demographics
NPI:1003401324
Name:BISHOP, KELLEY SMITH (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:SMITH
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10145 HIGHBURY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-4735
Mailing Address - Country:US
Mailing Address - Phone:804-387-8830
Mailing Address - Fax:
Practice Address - Street 1:9801 BROOK RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-4530
Practice Address - Country:US
Practice Address - Phone:804-264-9587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist