Provider Demographics
NPI:1932321999
Name:PARKS, KELLI (RPH)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:ABNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 CANEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9188
Mailing Address - Country:US
Mailing Address - Phone:502-316-1916
Mailing Address - Fax:
Practice Address - Street 1:106 MARKET PLACE CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-7400
Practice Address - Country:US
Practice Address - Phone:859-317-6080
Practice Address - Fax:859-317-6079
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009742183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist