Provider Demographics
NPI:1154691921
Name:LAMB, KELLIE FORBES (PHARMD)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:FORBES
Last Name:LAMB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 WHITE HERONS LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5859
Mailing Address - Country:US
Mailing Address - Phone:757-729-8791
Mailing Address - Fax:
Practice Address - Street 1:700 FREDERICK BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3314
Practice Address - Country:US
Practice Address - Phone:757-391-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist