Provider Demographics
NPI:1952901548
Name:KITCHEN, KELLY H (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:H
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2680
Mailing Address - Country:US
Mailing Address - Phone:740-434-1117
Mailing Address - Fax:
Practice Address - Street 1:2900 PIKE ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-8694
Practice Address - Country:US
Practice Address - Phone:304-489-3268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318788183500000X
WVRP0005074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist