Provider Demographics
NPI:1013945575
Name:PRATT, KELLY G (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:G
Last Name:PRATT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 S SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-4813
Mailing Address - Country:US
Mailing Address - Phone:806-385-4491
Mailing Address - Fax:806-385-4567
Practice Address - Street 1:1506 S SUNSET AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-4812
Practice Address - Country:US
Practice Address - Phone:806-385-4491
Practice Address - Fax:806-385-4567
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1225690001Medicare ID - Type Unspecified