Provider Demographics
NPI:1538561816
Name:HENSON, KELLY LYNN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:HENSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N BUCKMAN ST
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-5900
Mailing Address - Country:US
Mailing Address - Phone:502-543-2202
Mailing Address - Fax:
Practice Address - Street 1:532 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2553
Practice Address - Country:US
Practice Address - Phone:502-434-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027835183500000X
KY018904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist