Provider Demographics
NPI:1568931210
Name:PIEDRAHITA, KELLY MING (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MING
Last Name:PIEDRAHITA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:MING
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8903 PRIMULA DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20882-3806
Mailing Address - Country:US
Mailing Address - Phone:240-370-5625
Mailing Address - Fax:
Practice Address - Street 1:26075 RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1831
Practice Address - Country:US
Practice Address - Phone:301-253-9418
Practice Address - Fax:301-482-1179
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist