Provider Demographics
NPI:1215403944
Name:REYER, KELLY LAUREN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LAUREN
Last Name:REYER
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 1:11813 ISLAND LAKES LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6820
Mailing Address - Country:US
Mailing Address - Phone:561-809-4400
Mailing Address - Fax:
Practice Address - Street 1:6800 BROKEN SOUND PKWY NW
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2721
Practice Address - Country:US
Practice Address - Phone:561-961-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist