Healthcare Provider Details

I. General information

NPI: 1194240218
Provider Name (Legal Business Name): KELLI LEIGH TIONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 N QUEEN ST
MARTINSBURG WV
25404-3603
US

IV. Provider business mailing address

22 COLONIAL DR
CHARLES TOWN WV
25414-4493
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-1515
  • Fax:
Mailing address:
  • Phone: 304-995-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0010167
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: