Healthcare Provider Details

I. General information

NPI: 1568931210
Provider Name (Legal Business Name): KELLY MING PIEDRAHITA PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KELLY MING YU

II. Dates (important events)

Enumeration Date: 11/23/2018
Last Update Date: 11/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26075 RIDGE RD
DAMASCUS MD
20872-1831
US

IV. Provider business mailing address

8903 PRIMULA DR
GAITHERSBURG MD
20882-3806
US

V. Phone/Fax

Practice location:
  • Phone: 301-253-9418
  • Fax: 301-482-1179
Mailing address:
  • Phone: 240-370-5625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14973
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: