Provider Demographics
NPI:1578557781
Name:FINE, KELLY LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:FINE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:RIDGWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:15834 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1707
Mailing Address - Country:US
Mailing Address - Phone:480-241-1106
Mailing Address - Fax:
Practice Address - Street 1:1845 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5831
Practice Address - Country:US
Practice Address - Phone:480-838-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist