Provider Demographics
NPI:1881984086
Name:GREGORY, KELLY LORRAINE (PHARMD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LORRAINE
Last Name:GREGORY
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 1:1184 TEXAS PALMYRA HWY
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-7673
Mailing Address - Country:US
Mailing Address - Phone:570-253-0762
Mailing Address - Fax:570-253-5866
Practice Address - Street 1:1184 TEXAS PALMYRA HWY
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-7673
Practice Address - Country:US
Practice Address - Phone:570-253-0762
Practice Address - Fax:570-253-5866
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist