Provider Demographics
NPI:1013599562
Name:KELLY, KAILEN RENE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:KAILEN
Middle Name:RENE
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12637 TEALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8174
Mailing Address - Country:US
Mailing Address - Phone:317-650-6556
Mailing Address - Fax:
Practice Address - Street 1:326 E CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3809
Practice Address - Country:US
Practice Address - Phone:202-543-4400
Practice Address - Fax:202-543-6276
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028469A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist