Provider Demographics
NPI:1013421064
Name:PIREAUX, KELLY D (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:D
Last Name:PIREAUX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 HEALTH PARKWAY #130
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-378-0008
Mailing Address - Fax:941-378-0022
Practice Address - Street 1:6310 HEALTH PARKWAY #130
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-378-0008
Practice Address - Fax:941-378-0022
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist