Healthcare Provider Details

I. General information

NPI: 1952993107
Provider Name (Legal Business Name): ALANDRA KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S GADSDEN ST
TALLAHASSEE FL
32301-5506
US

IV. Provider business mailing address

770 APPLEYARD DR APT 6H
TALLAHASSEE FL
32304-2876
US

V. Phone/Fax

Practice location:
  • Phone: 850-521-5112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: