Provider Demographics
NPI:1609543057
Name:CHURCH, KAYLEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KAYLEY
Middle Name:
Last Name:CHURCH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8481
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-8481
Mailing Address - Country:US
Mailing Address - Phone:276-594-8980
Mailing Address - Fax:
Practice Address - Street 1:207 WOODLAND DR SW
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-4605
Practice Address - Country:US
Practice Address - Phone:276-328-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist