Healthcare Provider Details

I. General information

NPI: 1932321999
Provider Name (Legal Business Name): KELLI PARKS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLI ABNEY

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 06/28/2020
Certification Date: 06/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MARKET PLACE CIR
GEORGETOWN KY
40324-7400
US

IV. Provider business mailing address

128 CANEWOOD BLVD
GEORGETOWN KY
40324-9188
US

V. Phone/Fax

Practice location:
  • Phone: 859-317-6080
  • Fax: 859-317-6079
Mailing address:
  • Phone: 502-316-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number009742
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number009742
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: