Provider Demographics
NPI:1245553551
Name:LIDDINGTON, KELLY BREEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:BREEN
Last Name:LIDDINGTON
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 1:9930 KINCEY AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6541
Mailing Address - Country:US
Mailing Address - Phone:704-659-7848
Mailing Address - Fax:
Practice Address - Street 1:CONERS OF ROUTE 32 AND 23
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-0140
Practice Address - Country:US
Practice Address - Phone:518-622-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17828183500000X
NY054103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist