Provider Demographics
NPI:1821765546
Name:FAIRES, KAELI SHEA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KAELI
Middle Name:SHEA
Last Name:FAIRES
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 1:2614 35TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-2404
Mailing Address - Country:US
Mailing Address - Phone:682-241-3765
Mailing Address - Fax:
Practice Address - Street 1:4425 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2408
Practice Address - Country:US
Practice Address - Phone:067-882-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist