Provider Demographics
NPI:1821443557
Name:KELLY, ERICA JENKINS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:JENKINS
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 MARBURY CT APT 2C
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3239
Mailing Address - Country:US
Mailing Address - Phone:304-312-9878
Mailing Address - Fax:
Practice Address - Street 1:1273 NW MAYNARD RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8726
Practice Address - Country:US
Practice Address - Phone:919-380-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008564183500000X
OH03232919183500000X
VA0202213815183500000X
NC24867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist