Provider Demographics
NPI:1154554756
Name:ALLRIDGE, KELLIE LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:LYNN
Last Name:ALLRIDGE
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 1:4220 5TH STREET HWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-1738
Mailing Address - Country:US
Mailing Address - Phone:610-921-5141
Mailing Address - Fax:610-921-5141
Practice Address - Street 1:4220 5TH STREET HWY
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:PA
Practice Address - Zip Code:19560-1738
Practice Address - Country:US
Practice Address - Phone:610-921-5141
Practice Address - Fax:610-921-5141
Is Sole Proprietor?:No
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039242L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist