Provider Demographics
NPI:1639626112
Name:WALLS, KELLY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:WALLS
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 1:3109 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-3509
Mailing Address - Country:US
Mailing Address - Phone:901-293-4040
Mailing Address - Fax:
Practice Address - Street 1:3109 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3509
Practice Address - Country:US
Practice Address - Phone:901-293-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35883183500000X
ARPD12194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist