Provider Demographics
NPI:1609453570
Name:SHORT, KELLY BRIDGERS (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:BRIDGERS
Last Name:SHORT
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 1:10 HERMAN AVENUE EXT STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8103
Mailing Address - Country:US
Mailing Address - Phone:888-768-4092
Mailing Address - Fax:844-230-5200
Practice Address - Street 1:10 HERMAN AVENUE EXT STE C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8103
Practice Address - Country:US
Practice Address - Phone:888-768-4092
Practice Address - Fax:844-230-5200
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist