Provider Demographics
NPI:1508272121
Name:FUNK, KELLI CARPENTER (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:CARPENTER
Last Name:FUNK
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 1:1600 ORMSBY STATION CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4039
Mailing Address - Country:US
Mailing Address - Phone:502-423-4113
Mailing Address - Fax:502-423-4176
Practice Address - Street 1:1600 ORMSBY STATION CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4039
Practice Address - Country:US
Practice Address - Phone:502-423-4113
Practice Address - Fax:502-423-4176
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist