Provider Demographics
NPI:1194053546
Name:WERNIMONT, KELLY E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:E
Last Name:WERNIMONT
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 1:19203 STONE OAK PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3254
Mailing Address - Country:US
Mailing Address - Phone:210-403-0002
Mailing Address - Fax:210-403-0740
Practice Address - Street 1:19203 STONE OAK PKWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3254
Practice Address - Country:US
Practice Address - Phone:210-403-0002
Practice Address - Fax:210-403-0740
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist