Provider Demographics
NPI:1871161240
Name:LAMB, KELLY ANN
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:LAMB
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 1:8479 BURPEE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7420
Mailing Address - Country:US
Mailing Address - Phone:810-636-7986
Mailing Address - Fax:
Practice Address - Street 1:841 S STATE RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1751
Practice Address - Country:US
Practice Address - Phone:810-653-7485
Practice Address - Fax:810-658-9535
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303008624183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician