Healthcare Provider Details

I. General information

NPI: 1699689778
Provider Name (Legal Business Name): KELLI MARIE SHIRLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N RACE ST
GLASGOW KY
42141-3483
US

IV. Provider business mailing address

204 AUTUMN RIDGE RD
GLASGOW KY
42141-7093
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-1866
  • Fax: 270-651-1867
Mailing address:
  • Phone: 270-651-1866
  • Fax: 270-651-1867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number011597
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: