Provider Demographics
NPI:1558798181
Name:KELLY, KRISTEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:KELLY
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 1:3504 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-3225
Mailing Address - Country:US
Mailing Address - Phone:410-935-1905
Mailing Address - Fax:
Practice Address - Street 1:5809 DEALE CHURCHTON RD
Practice Address - Street 2:
Practice Address - City:DEALE
Practice Address - State:MD
Practice Address - Zip Code:20751-2203
Practice Address - Country:US
Practice Address - Phone:410-867-2455
Practice Address - Fax:410-867-2466
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist