Provider Demographics
NPI:1457773145
Name:KELLOW, KEVIN TRENOUTH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TRENOUTH
Last Name:KELLOW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 S ARKANSAS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:LA
Mailing Address - Zip Code:71075-4320
Mailing Address - Country:US
Mailing Address - Phone:318-539-3500
Mailing Address - Fax:318-539-2522
Practice Address - Street 1:1920 S ARKANSAS ST
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:LA
Practice Address - Zip Code:71075-4320
Practice Address - Country:US
Practice Address - Phone:318-539-3500
Practice Address - Fax:318-539-2522
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist