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General NPI Number Information
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NPI Number | 1407106784
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Entity Type | Individual
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Provider Name | KELLI DENISE FAIRLEY PHARM D
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Gender | Female
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 2401 W ATLANTIC BLVD
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City | POMPANO BEACH
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State | FL
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Zip | 33069-2634
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Country | US
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Telephone | 954-861-5672
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 NW 190TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-2733
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Country | US
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Telephone | 850-712-7223
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Fax | 866-788-9477
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 49753
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License Number State | FL
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