Provider Demographics
NPI:1134724081
Name:PELFREY, MIA RENEE (PHARMD)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:RENEE
Last Name:PELFREY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1983
Mailing Address - Country:US
Mailing Address - Phone:859-744-7701
Mailing Address - Fax:859-744-2145
Practice Address - Street 1:24 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1983
Practice Address - Country:US
Practice Address - Phone:859-744-7701
Practice Address - Fax:859-744-2145
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist