Provider Demographics
NPI:1902180094
Name:BIRDWELL, KELLY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:BIRDWELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 KIMBALL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4409
Mailing Address - Country:US
Mailing Address - Phone:678-566-0422
Mailing Address - Fax:678-566-3112
Practice Address - Street 1:4395 KIMBALL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4409
Practice Address - Country:US
Practice Address - Phone:678-566-0422
Practice Address - Fax:678-566-3112
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist