Provider Demographics
NPI:1437314226
Name:DONOVAN, KELLYE ANN (PHARM D, MHA, PHD)
Entity Type:Individual
Prefix:
First Name:KELLYE
Middle Name:ANN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PHARM D, MHA, PHD
Other - Prefix:
Other - First Name:KELLYE
Other - Middle Name:ANN
Other - Last Name:LOETHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48 SURVEYORS WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8602
Mailing Address - Country:US
Mailing Address - Phone:401-835-7939
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008020954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist