Provider Demographics
NPI:1811003072
Name:CONDON, KELANI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELANI
Middle Name:
Last Name:CONDON
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 1:1100 W. 49TH ST.
Mailing Address - Street 2:PHARMACY BRANCH
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756
Mailing Address - Country:US
Mailing Address - Phone:512-776-7500
Mailing Address - Fax:512-776-7489
Practice Address - Street 1:1100 W. 49TH ST.
Practice Address - Street 2:PHARMACY BRANCH
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756
Practice Address - Country:US
Practice Address - Phone:512-776-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43385T183500000X
TX43385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist