Provider Demographics
NPI:1629230255
Name:MCDONALD, KELLY ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:MCDONALD
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 1:2355 POPLAR LEVEL RD
Mailing Address - Street 2:STE 302
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1395
Mailing Address - Country:US
Mailing Address - Phone:502-636-8088
Mailing Address - Fax:502-636-8078
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:STE 302
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-636-8088
Practice Address - Fax:502-636-8078
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0133111835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY013311OtherPHARMACIST LICENSE