Provider Demographics
NPI:1881871812
Name:PAUL, KELLY (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:PAUL
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 1:100 ST MARYS EPWORTH XING STE A001
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9497
Mailing Address - Country:US
Mailing Address - Phone:812-469-8177
Mailing Address - Fax:812-469-8333
Practice Address - Street 1:100 ST MARYS EPWORTH XING STE A001
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9497
Practice Address - Country:US
Practice Address - Phone:812-469-8177
Practice Address - Fax:812-469-8333
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022087A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist