Provider Demographics
NPI:1093302945
Name:KISHEL, KELLY JOY
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JOY
Last Name:KISHEL
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 1:1 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3706
Mailing Address - Country:US
Mailing Address - Phone:610-368-4029
Mailing Address - Fax:
Practice Address - Street 1:1218 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2616
Practice Address - Country:US
Practice Address - Phone:610-519-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4410893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy