Provider Demographics
NPI:1790031599
Name:GRITTON, KELLY GRAVES (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:GRAVES
Last Name:GRITTON
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 1:1313 SAINT ANTHONY PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1740
Mailing Address - Country:US
Mailing Address - Phone:502-627-1749
Mailing Address - Fax:502-627-1210
Practice Address - Street 1:1313 SAINT ANTHONY PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1740
Practice Address - Country:US
Practice Address - Phone:502-627-1749
Practice Address - Fax:502-627-1210
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist