Provider Demographics
NPI:1821705146
Name:SEIDEL, KELLY BROPHY (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:BROPHY
Last Name:SEIDEL
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 1:1136 BLYKEFORD LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8037
Mailing Address - Country:US
Mailing Address - Phone:919-889-2353
Mailing Address - Fax:
Practice Address - Street 1:13686 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6607
Practice Address - Country:US
Practice Address - Phone:919-554-3226
Practice Address - Fax:919-554-3809
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042264L183500000X
NC16765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist