Provider Demographics
NPI:1891898516
Name:KELLY, KIRSTEN LYNN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:LYNN
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:KIRI
Other - Middle Name:LYNN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9750 HIGHWAY 69 S
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-8777
Mailing Address - Country:US
Mailing Address - Phone:205-366-9626
Mailing Address - Fax:205-366-1662
Practice Address - Street 1:9750 HIGHWAY 69 S
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-8777
Practice Address - Country:US
Practice Address - Phone:205-366-9626
Practice Address - Fax:205-366-1662
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist