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General NPI Number Information
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NPI Number | 1902100894
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Entity Type | Individual
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Provider Name | KATHIE KELLUM RPH
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Gender | Female
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Dates
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Enumeration Date | 01/06/2011
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 399 MULBERRY AVE
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City | SELMER
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State | TN
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Zip | 38375-2305
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Country | US
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Telephone | 731-645-6182
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Fax | 731-645-6001
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Provider Business Mailing Address
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Address Line | 68 COUNTY ROAD 68
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City | GOLDEN
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State | MS
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Zip | 38847-7756
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Country | US
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Telephone | 662-454-7558
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Fax | 731-645-6001
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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 | 8385
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License Number State | TN
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