Provider Demographics
NPI:1871874180
Name:HAYSE, KELLY LEIGH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LEIGH
Last Name:HAYSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-3203
Mailing Address - Country:US
Mailing Address - Phone:540-674-5261
Mailing Address - Fax:540-674-5154
Practice Address - Street 1:240 BROAD ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3203
Practice Address - Country:US
Practice Address - Phone:540-674-5261
Practice Address - Fax:540-674-5154
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist