MEDICARE: KELLEY TRANG DU-CUNNINGHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03325363	OH

General Provider Information

NPI Number	:	1659900108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY TRANG DU-CUNNINGHAM

Provider Business Mailing Address
First Line	:	1133 RIVERMEADE DR
Second Line	:
City	:	HEBRON
State	:	KY
Zip	:	41048-7307
Country	:	US
Telephone Number	:	513-226-3050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1143 SMILEY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1832
Country	:	US
Telephone Number	:	513-825-3804
Fax Number	:	513-825-3809

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	04/06/2020

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