Provider Demographics
NPI:1114013331
Name:MORAN, KELLY LYN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYN
Last Name:MORAN
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:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-0910
Mailing Address - Country:US
Mailing Address - Phone:605-745-2000
Mailing Address - Fax:605-745-2066
Practice Address - Street 1:500 N 5TH ST
Practice Address - Street 2:PHARMACY
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-1480
Practice Address - Country:US
Practice Address - Phone:605-745-2000
Practice Address - Fax:605-745-2966
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist