Provider Demographics
NPI:1750830006
Name:GRAPPE, KELLEY BURT (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:BURT
Last Name:GRAPPE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 AVERA ST
Mailing Address - Street 2:PO BOX 159
Mailing Address - City:SAREPTA
Mailing Address - State:LA
Mailing Address - Zip Code:71071-2566
Mailing Address - Country:US
Mailing Address - Phone:318-453-0617
Mailing Address - Fax:
Practice Address - Street 1:27 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:LA
Practice Address - Zip Code:71075-3241
Practice Address - Country:US
Practice Address - Phone:318-539-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist