Provider Demographics
NPI:1205359965
Name:MILLWOOD, KELLEY LECHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:LECHELLE
Last Name:MILLWOOD
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 1:194 SERENITY LN
Mailing Address - Street 2:
Mailing Address - City:DOUBLE SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:35553-2575
Mailing Address - Country:US
Mailing Address - Phone:205-272-0391
Mailing Address - Fax:205-486-8966
Practice Address - Street 1:1706 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-5021
Practice Address - Country:US
Practice Address - Phone:205-921-2889
Practice Address - Fax:205-921-2834
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist