Provider Demographics
NPI:1902121031
Name:STRANGE, KELLI BRANNON (RPH)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:BRANNON
Last Name:STRANGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-4289
Mailing Address - Country:US
Mailing Address - Phone:334-836-0890
Mailing Address - Fax:334-836-0894
Practice Address - Street 1:1909 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4289
Practice Address - Country:US
Practice Address - Phone:334-836-0890
Practice Address - Fax:334-836-0894
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12640183500000X
FLPS0028447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist