Provider Demographics
NPI:1447914957
Name:ALBRIGHT, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ALBRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8321 W STATE ROAD 56
Mailing Address - Street 2:
Mailing Address - City:WEST BADEN SPRINGS
Mailing Address - State:IN
Mailing Address - Zip Code:47469-9655
Mailing Address - Country:US
Mailing Address - Phone:812-936-7272
Mailing Address - Fax:812-936-7543
Practice Address - Street 1:8321 W STATE ROAD 56
Practice Address - Street 2:
Practice Address - City:WEST BADEN SPRINGS
Practice Address - State:IN
Practice Address - Zip Code:47469-9655
Practice Address - Country:US
Practice Address - Phone:812-936-7272
Practice Address - Fax:812-936-7543
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019723A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist