Provider Demographics
NPI:1235731191
Name:CARRIER, KELLY NICOLA
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:NICOLA
Last Name:CARRIER
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 1:1115 BETTSTRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-5537
Mailing Address - Country:US
Mailing Address - Phone:301-424-8360
Mailing Address - Fax:
Practice Address - Street 1:13060 MIDDLEBROOK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2617
Practice Address - Country:US
Practice Address - Phone:301-428-9115
Practice Address - Fax:844-411-6262
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist