Provider Demographics
NPI:1821642828
Name:KELLY, ONDREA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ONDREA
Middle Name:
Last Name:KELLY
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 1:4315 GOLF CLUB DR APT 6506
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2155 WALKER BUILDING
Practice Address - Street 2:
Practice Address - City:AUBURN UNIVERSITY
Practice Address - State:AL
Practice Address - Zip Code:36849-0001
Practice Address - Country:US
Practice Address - Phone:344-844-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPST.023038OtherPHARMACY LICENSE