Provider Demographics
NPI:1952600892
Name:OWENS, KELLY ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:OWENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:FREER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4212 NORTH 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016
Mailing Address - Country:US
Mailing Address - Phone:602-263-1200
Mailing Address - Fax:602-263-1621
Practice Address - Street 1:4212 NORTH 16TH STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-263-1200
Practice Address - Fax:602-283-1621
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014554P183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist