Provider Demographics
NPI:1083095038
Name:MURPHY, KELLY ANNE
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 SHETLAND CT
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9692
Mailing Address - Country:US
Mailing Address - Phone:502-773-3062
Mailing Address - Fax:
Practice Address - Street 1:1125 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2371
Practice Address - Country:US
Practice Address - Phone:812-284-5139
Practice Address - Fax:812-590-4349
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN45017001A183500000X
KY109947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist