Provider Demographics
NPI:1518433846
Name:OWENS, KELLI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:OWENS
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 1:5958 SNOW HILL RD STE 168
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7834
Mailing Address - Country:US
Mailing Address - Phone:423-238-2105
Mailing Address - Fax:
Practice Address - Street 1:5958 SNOW HILL RD STE 168
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7834
Practice Address - Country:US
Practice Address - Phone:423-238-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021693183500000X
TN33449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist