Provider Demographics
NPI:1891026704
Name:KREIDER, KELLY S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:S
Last Name:KREIDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 THOMPSON ST APT 16
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 GREENWICH ST # LL5155
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2383
Practice Address - Country:US
Practice Address - Phone:646-822-4717
Practice Address - Fax:212-822-4718
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017406183500000X
NY060219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist