Healthcare Provider Details

I. General information

NPI: 1750201331
Provider Name (Legal Business Name): KELLI ANN PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N LAKEMONT AVE
WINTER PARK FL
32792-3273
US

IV. Provider business mailing address

3587 S SAINT LUCIE DR
CASSELBERRY FL
32707-5534
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7460
  • Fax:
Mailing address:
  • Phone: 772-240-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS53388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: