Provider Demographics
NPI:1518680081
Name:DENNIS, KALLIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KALLIE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:KALLIE
Other - Middle Name:
Other - Last Name:EPPERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 TIMOTHY LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-3430
Mailing Address - Country:US
Mailing Address - Phone:770-286-5266
Mailing Address - Fax:
Practice Address - Street 1:916 LOGANVILLE HWY
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-2144
Practice Address - Country:US
Practice Address - Phone:678-975-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist