Provider Demographics
NPI:1326638826
Name:KELLEY, LELA SMITH (PHARMD)
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:SMITH
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LELA
Other - Middle Name:KATHERINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3525 ROSS CLARK CIRCLE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303
Mailing Address - Country:US
Mailing Address - Phone:334-792-4812
Mailing Address - Fax:334-792-4628
Practice Address - Street 1:3525 ROSS CLARK CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-792-4812
Practice Address - Fax:334-792-4628
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist