Provider Demographics
NPI:1710587365
Name:LEWIS, KELLY CAROLE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CAROLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5398 E LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-6882
Mailing Address - Country:US
Mailing Address - Phone:606-312-1659
Mailing Address - Fax:
Practice Address - Street 1:103 BRYANT DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8058
Practice Address - Country:US
Practice Address - Phone:859-881-1647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist