Provider Demographics
NPI:1982577334
Name:HARRELL, KALEIGH AMANDA (PHARMD, MMHC)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:AMANDA
Last Name:HARRELL
Suffix:
Gender:F
Credentials:PHARMD, MMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 AMANDA BELLE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-9529
Mailing Address - Country:US
Mailing Address - Phone:225-573-4966
Mailing Address - Fax:
Practice Address - Street 1:116 N PAULINE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-1005
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.025868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist