Provider Demographics
NPI:1467868661
Name:AUTEN, KELLEY MILLER (PHARMD, CPP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:MILLER
Last Name:AUTEN
Suffix:
Gender:F
Credentials:PHARMD, CPP
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1126 N CHURCH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1037
Mailing Address - Country:US
Mailing Address - Phone:336-938-0800
Mailing Address - Fax:336-938-0757
Practice Address - Street 1:1126 N CHURCH ST STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401
Practice Address - Country:US
Practice Address - Phone:336-938-0800
Practice Address - Fax:336-938-0757
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24253183500000X
NC7001021835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist