Healthcare Provider Details

I. General information

NPI: 1285914788
Provider Name (Legal Business Name): ANNE KELLOGG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BUTTERMILK PIKE
CRESCENT SPRINGS KY
41017-1302
US

IV. Provider business mailing address

252 OFALLON AVE
BELLEVUE KY
41073-1202
US

V. Phone/Fax

Practice location:
  • Phone: 859-344-1824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15136
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: