Provider Demographics
NPI:1770573693
Name:WHITLEY DE PADILLA, KELLY DENICE (RPH)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DENICE
Last Name:WHITLEY DE PADILLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:D
Other - Last Name:WHITLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:114 W WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2848
Mailing Address - Country:US
Mailing Address - Phone:919-201-8507
Mailing Address - Fax:
Practice Address - Street 1:114 W WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2848
Practice Address - Country:US
Practice Address - Phone:919-201-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-22
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist