Provider Demographics
NPI:1326593575
Name:JONES, KELLI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:JONES
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 1:210 BLACK GOLD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 BLACK GOLD BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2620
Practice Address - Country:US
Practice Address - Phone:606-487-7380
Practice Address - Fax:606-487-7384
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist