Provider Demographics
NPI:1770607764
Name:JENNINGS, KELLI LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:LYNN
Last Name:JENNINGS
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 1:8603 BENTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4714
Mailing Address - Country:US
Mailing Address - Phone:804-762-4540
Mailing Address - Fax:
Practice Address - Street 1:3107 BOULEVARD STE 15
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2405
Practice Address - Country:US
Practice Address - Phone:804-520-4106
Practice Address - Fax:804-520-8396
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist