Provider Demographics
NPI:1790068377
Name:KELLEY, AMANDA KERR (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KERR
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:922 E MAINST
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-3616
Mailing Address - Country:US
Mailing Address - Phone:864-682-8104
Mailing Address - Fax:864-683-5760
Practice Address - Street 1:922 E MAINST
Practice Address - Street 2:PHARMACY
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-3616
Practice Address - Country:US
Practice Address - Phone:864-682-8104
Practice Address - Fax:864-683-5760
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22014183500000X
PARP447604183500000X
SCSC35905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist