Provider Demographics
NPI:1720358609
Name:DIGHTON, KELLY MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIE
Last Name:DIGHTON
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 1:209 E SAN MARNAN DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5839
Mailing Address - Country:US
Mailing Address - Phone:319-236-8891
Mailing Address - Fax:319-236-9665
Practice Address - Street 1:209 E SAN MARNAN DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5839
Practice Address - Country:US
Practice Address - Phone:319-236-8891
Practice Address - Fax:319-236-9665
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292755183500000X
IA20827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist